(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Harvard medical alumni bulletin"






m 



'H-'i-'AM 






■vyMim 









^Harvard Medical 

^ AlOO MNI BULLETIN SUMMER 1996 




1^ Considering 
SHP ^ tlie Alternatives 

I^B^Vi.* 










c 


m^ Jir J 


^i^A'i' 






N^4- j| 



-=-»W*«Wif«tB M.»l fW» f » |. > »»t<^i,. 



^ !!3» !S» %> !Bb » !!>* !» 3t< "i« !9» :ak !&. ^^^ 



THE TRAGEDY ISN'T THAT 

SHE HAS CANCER. IT'S THAT 

WHEN THIS PICTURE WAS 

TAKEN SHE WAS MISSING 

HER TREATMENT. 

It's sad, but true. 
You see, even 
though medical 
science has given 
more cancer 
oatients more 
iope than ever 
before, one of the 
most critical 
challenges facing 
these people is 
'^ simply getting to 
their treatments. 
But you can help. And we hope you will. 
'K_ Through the American Cancer Society's Road To 
Recovery program, you can volunteer to 
drive a cancer patient to and from 
treatment. And, in turn, help them 
enjoy a fuller, longer life. 
%. To find out more, call your American 
Cancer Society at 1 -800-ACS-2345. 
Because the only thing sadder than 
this picture is that we have more of AAAERICAN 
thern V CANCER 

fsOCIETY^ 

THERE'S NOTHING 
MIGHTIER THAN THE SWORD 






Summer 1996 
Volume 70 Number i 



Harvard Medical 



ALUMNI 



BULLETIN 




Cover photo by Stuart Darsch 
Rug courtesy of 
Decor International 



20 The Invisible Mainstream 

by David M. Eisenberg 
Millions of Americans are using 
alternative therapies, but which 
ones really work and why? 
Setting a New Course 
by Ellen Barlow 

26 Call for a New Medicine 

by James S. Gordon 

A healing partnership of doctor and 

patient, and conventional with the 

unconventional. 

No Turning Back 

by Ellen Barlow 

34 Mesmerism and Kindred Delusions 

by Gerald Weissman 

What Oliver Wendell Holmes 

would make of millennial medicine. 

40 Wired for God 

Excerpt by Herbert Benson from 
Timeless Healing: The Power and 
Biology of Belief. 



Departments 
3 Letters 

6 Pulse 

Dean Tosteson to step down, 
student debt relief, lead links, 
Hyman to NIMH, Braunwald takes 
on new role. Match Day results. 

14 On the Quadrangle 

Countway campaign, Harvard 
Medical International. 

18 Book Mark 

Gefies, Blood and Courage: A Boy Called 
Immortal Sword by David G. Nathan; 
reviewed by Elissa Ely. 

53 Alumni Notes 

60 In Memoriam 

Claude E. Welch 

62 Death Notices 



45 Rebel with a Cause 

by Sarah Jane Nelson 

An interview with Andrew Weil '68. 

46 Native Healing 

by Scott H. Nelson, Mary Ann ^Neal 
and Abe Flummer 

Traditional medicine is increasingly 
practiced as many American Indian 
and Alaska Native tribes rekindle 
their languages and culture. 



50 Who Did the First Appendectomy? 

by S. Halciiit Moore 



Inside hmab 



Harvard Medical 



A L u M N 



BULLET 



By some estimates, Americans spend as much on "alterna- 
tive" medicine as the billions of dollars they spend annually 
on hospital care provided in the mainstream. Many are quiet- 
ly supporting both the establishment and the fringes. What 
are they pursuing with their money? I would speculate that a 
relatively small fraction is spent by the terminally ill in the 
pursuit of desperate cures when all else has failed and that a 
much larger amount goes to seek relief of everyday suffering. 

Regular medicine has on the whole adopted a selective 
approach to the problem of pain. We treat what we can 
and assign the rest, with some exceptions, to a category of 
discomfort that is more or less unreal. There's a solid 
tradition for this. One of the pragmatic Egyptian papyri 
recommends that physicians first decide whether or not a 
chief complaint is in the realm of things they can contend 
with and then explicitly state whether they intend to 
proceed with treatment. 

This is not unreasonable, even now. It clarifies the 
doctor's role, grounds medicine in empirical science, and 
provides a semisolid basis for third-party reimbursement. In 
the event, however, it has left open an enormous market for 
the "alternative." 

Alumni and faculty of HMS (which as an institution 
adheres to high-church scientific medicine) are remarkably 
prominent in the alternative chapels (and they are prolific 
authors on the subject). This issue offers a sampling of 
commentary and observations from Harvard physicians 
engaged one way or another with "alternative" practice. 

We also carry an engaging article by Halcuit Moore '35 
on one of the most accepted of medical practices, appendec- 
tomy. Moore reminds us how uncertain is the parentage of 
even our most legitimate treatments. 

With this issue, we welcome Janet Walzer as associate 
editor of HMAB. She comes to us from Beth Israel Hospital 
where she was managing editor of the Journal of the American 
Medical Association''s "Clinical Crossroads" series. 

William Ira Bennett ''68 



Editor-in.chief 

William Ira Bennett '68 

Editor 

Ellen Barlow 

Associate Editor 

Janet Walzer 

Assistant Editor 

Sarah Jane Nelson 

Editorial Board 

Elissa A. Ely '88 
MeUnda Fan '96 
Robert M. Goldwyn '56 
Joshua Hauser '95 
Paula A. Johnson '84 
Victoria McEvoy '75 
James J. O'Connell '82 
Gabriel Otterman '91 
Deborah Prothrow-Stith '79 
Guillermo C. Sanchez '49 
J. Gordon Scannell '40 
Eleanor Shore '55 
John D. Stoeckle '47 
Richard J. Wolfe 

Design Direction 

Sametz Blackstone Associates, Inc. 

Association Officers 

Stephanie H. Pincus '68, president 
Suzanne Fletcher '66, president-elect i 
Robert S. Lawrence '64, president-elect 2 
Roman W. DeSanctis '55, vice president 
Nancy A. Rigotti '78, secretary 
Arthur R. Kravitz '54, treasurer 

Councillors 

Kenneth Roland Bridges '76 
David P. Gilmour '66 
Katherine L. Griem '82 
Dana Leifer '85 
Sharon B. Murphy '69 
Gilbert S. Omenn '65 
Bruce J. Sams Jr. '55 
John B. Stanbury '39 
Lorraine Dudley Stanfield '87 

Director of Alumni Relations 

Daniel D. Federman '53 

Representative to the Harvard Alumni Association 

Chester d'Autremont '44 

ID Statement: 

The Harvard Medical Alumni Bulletin is pubhshed 
quarterly at 25 Shattuck Street, Boston, ma 02 115 
© by the Harvard Medical Alumni Association. 
Telephone: (617) 432-1548. Email address: 
bulletin@warren.med.harvard.edu. Web site address: 
http://www.med.harvard.edu/pubUcations/HMAB/ 
Third class postage paid at Boston, Massachusetts. 
Postmaster, send form 3579 to 25 Shattuck Street, 
Boston, MA02ii5,isSNoi9i-7757. Printed in the 
U.S.A. 



Harvard Medical Alumni Bulletin 



Letters 



Cyberhype 

Even though I'm one of your "old/old 
readers," I can claim the possession 
and operation of a computer. This 
makes it especially easy for me to 
understand the limitations of comput- 
ers as a "way of doctoring." 

The articles about medical teaching 
and care as mediated through a com- 
puter, appearing at length in your 
Spring 1996 issue, raise some possibiH- 
ties. Unfortunately, they completely 
neglect the disadvantages of shifting 
from human contact to electronic net- 
works, in medical care and teaching. 

Only in ]erry Kassirer's article is 
any mention made of physical/per- 
sonal contact with the patient, and he 
only refers to the "laying on of hands." 
While this image calls to mind the 
allegedly therapeutic value of the per- 
sonal touch, it is the matter of the 
physical examination that is com- 
pletely neglected in these articles. 

Without a careful physical exami- 
nation, medical care is impossible. 
Glossing over the physical examina- 
tion (as for example, avoiding exami- 
nation with an ophthalmoscope, a 
pelvic or a rectal examination) has 
been the basis of repeated disasters of 
medical care in the last 20 or 30 years. 

Most especially, a consultation 
requires personal contact with the 
patient. The consultant comes to the 
patient with a recent wound that is not 
doing quite well, and with his fingers 
can feel the telltale tiny bubbles of gas 
gangrene. A life is saved by a touch of 
the hand. The physician requesting the 
consultation would never have men- 
tioned these in his computer request 
because he did not feel the bubbles him- 
self! Daily personal contact and exami- 
nation is essential in all patient care. 

There are reliable stories of "com- 
puter medicine" at an airport (not in 
this city) that missed a ruptured spleen 
and a fractured ankle. 



According to one of the Bulletin 
articles, patients seemed to enjoy being 
interviewed by the computer. Therein 
lies a severe problem, as any psycholo- 
gist, psychiatrist, physician, or even 
surgeon can tell you. If questions are 
asked that seem somehow to probe 
into difficult areas of the patient's 
background, and might even be a little 
unpleasant, those are the most impor- 
tant questions to follow up, and their 
answers may hold the key. The matter 
must be pursued with tact and, yes, 
humanity. No machine can sense the 
"tough question" and the patient can 
just skip it. 

HMS, in looking at this "cyberhype" 
world should realize that our emphasis 
should be on the importance of "real- 
ity" and of "real people giving real 
care." If we indulge in rhetoric about 
computers, it should be to indicate 
their shortcomings, their failings. We 
should show how those specific failings 
can be minimized by personal real- 
time friendly human interest, concern 
and presence. Only those who have 
dealt with the sick themselves, or with 
students, should write about the glo- 
ries of cyberspace for the computer. 

Once upon a time a student asked, 
"How do you define space?" The 
teacher answered, "a cubic volume in 
which there is almost nothing." That 
is a very good definition of cyberspace. 

Francis D. Moore '35? 

The Human Interface 

What fun it was to read the Spring 
sci-fi edition of the Bulletin and to 
share the glimpses of the future from 
all those Jules Verne, MDs. There is no 
question that the computer did usher 
in a new player in our lives. But we 
must not let the technical imperative 
beguile us. 

I acquired an Apple n in 1980 quite 
a few years after I had attended a 
Harvard Alumni College introductory 



course in computing. At that time 
Professor Bossert concluded his week 
of lectures and hands-on experience 
with the remark that he "did not know 
how we would put to use what we 
had learned but that we would sooner 
or later." 

I was probably the first solo 
practitioner in Boston's Metro West 
to install a PC in his office. I made an 
unorthodox use of a database program 
(DBMaster by Barney Stone) to do my 
billing, which allowed me to downsize 
my staff by one person. I subscribed to 
Saunders "Colleague After Dark" and 
surfed Medline in the off hours look- 
ing up cancer protocols or references 
for medical articles that I had written. 
I used a word processor program to 
write a biography (only to find the 
publisher still hired a typist to key in 
all the text since he was not capable of 
dealing with my disks). Yet, in retro- 
spect, I was doing nothing more than 
what my secretaries and the hospital 
librarians had been doing for me in the 
previous decade of clinical research 
and publishing. 

But what was more significant was 
my relationship with my patients or 
referring physicians. In spite of the 
fact that my desk could be heaped with 
all the latest computer searches about 
the treatment of a disease, people 
came to me seeking my advice as what 
was best to do. They did not care how 
many protocols or clinical reports I 
was able to print out from all over the 
world. They trusted me to make the 
discriminating choices about what was 
good or what was marginal in medical 
progress; and they trusted I would do 
my best in using those decisions to 
render their care. 

The practicing clinician will still be 
the keeper of that weir in the stream of 
information, trapping just enough to 
be effective. The human interface 
between patient and doctor will never 



Summer 1996 



Letters 



(and has not been since the days of the 
temions of Aesculapius) be changed 
by all the pie-in-the-sky technology 
we can dream up. This humanism 
should still be given its due respect 
and priority. 

C. Newton Peabody '48 

The Final Push 

Thank you, thank you. Your spring 
issue devoted to the coming brave new 
world of compu-medicine was the final 
and decisive push this clinical practi- 
tioner, 44 years out of HMS, needed to 
slip gratefully into retirement. Only 
four years ago the theme of the Class 
Day program at our 40th reunion 
was the doctor/patient relationship. 
This will soon be dismembered in the 
on-line future hastened by cost-driven 
HMOs which continue to synergistically 
depersonalize medical care. 

Yet Jerome Kassirer admonishes 
us to be "at the forefront of these 
changes, not dragged along by 
progress." Progress! I knew it was 
quitting time when even Editor 
Kassirer was unable or unwiUing to 
distinguish between change and 
progress. 

James S. Bernstein '52 



With a elicit of the Mouse 

As a practicing psychiatrist, William 
Ira Bennett ("Solitaire Confinement," 
Spring 1996) is aware that addicts can 
often offer sustenance and support to 
each other. Unfortunately, I can only 
offer compassion. An addict should not 
trifle with the facts, however. He will 
certainly be exposed! FreeCell and 
Mac? Such a figment of the imagina- 
tion! Such disloyalty to the evil bard 
of Microsoft Manor! 

Alas poor sir, the mighty ace will 
not save you. More is revealed with a 
right click of the mouse. Luck does 
not reign! Failure is but thine! 

Charles G. Mixter III '6^ 

Bennett replies: 

Confession is good for the soul but bad for 
the reputation. Dr. Mixter is coivect on 
two counts. I play Fi'eeCell on a PC with 
Windows ^. I. Our designers, however, use 
Macs to produce ait for the magazine. 
And pressing the right butt07i of the mouse 
does expose the aces. (Havijtg learned the 
trick from Dr. Mixter, I find that it 
makes virtually no difference to my game). 
Meanwhile Nora Nercessian (exeaitive 
director of alumni relations) has almost 
convinced me that I really could win all 
the games if I would only persevere. 



Diversity Reconfirmed 

In a letter printed in the last issue of 
the Bulletin, William Campbell writes 
that he perceives Harvard to be filled 
with those "jabbering in foreign 
tongues" and to have been subjected to 
a "takeover of the school by affirmative 
action women students." Campbell 
calls for HMS to change its admissions 
policy to "reverse this trend." 

This view is perfect justification for 
why HMS must continue to place great 
importance on creating a diverse stu- 
dent body. We must keep working to 
build a community where people of 
different backgrounds feel comfortable 
with each other and do not look upon 
each other with suspicion and feelings 
of ahenation. This can only be accom- 
plished if we share our experiences and 
work for common goals with those 
who do not have the same background 
as ourselves. 

As doctors, we will be helping an 
American society made up of people 
who have origins and experiences very 
different from our own. It is our 
responsibility to treat everyone with 
equal compassion and to look upon 
each person as an individual of worth. 
Our ability to accomplish this begins 
with our ability to regard peers of dif- 
ferent background with respect and 
understanding. 

I was saddened to read that 
Campbell does not feel welcome in 
Vanderbilt Hall because of the large 
number of individuals there who were 
different from him. Perhaps he would 
benefit from spending time with 
our diverse and friendly medical 
school class. 

Maureen A. Su ^gg 



Harvard Medical Alumni Bulletin 



I am writing in response to a letter in 
the Spring 1996 issue of the Bulletin by 
WilHam Neil Campbell Jr. '38. 
Campbell wrote that walking into 
Vanderbilt Hall was like "walking into 
some East Asian school — no responses 
to my greetings and much jabbering in 
foreign tongues." As a native born 
American, I have found that the ability 
to speak a foreign language has been 
extremely useful in communicating 
with patients who do not speak 
English, and it is unfortunate that 
Campbell views the speaking of for- 
eign languages as "jabbering," rather 
than as a useful communication skill. 

Campbell also states: "the takeover 
of the school by affirmative action 
women students I cannot stand... it is 
high time for a reversal of this trend." 
I have spoken to faculty and student 
members of the admissions committee 
and have learned that women are not 
admitted by affirmative action. In fact, 
the dean of admissions, Gerald Foster, 
has stated in US News and World 
Report that women tend to interview 
better than men, and this may account, 
in part, for their success at gaining 
admission. Those who interview well 
tend to have excellent communication 
skills, a trait that all good doctors 
must have. 

I believe that Campbell's opinions 
stem from his lack of familiarity with 
the realities of medical student life 
today. He should visit the medical 
school again and get to know the stu- 
dents better. I am sure he would 
discover that we are carrying on the 
fine tradition of outstanding medical 
training, and at the same time, bring- 
ing perspectives and talents to the 
medical profession that may not have 
been present at HMS in the 1930s. 

What disturbs me most about this 
letter is that there is likely to be a sig- 
nificant number of doctors who hold 
opinions similar to Campbell's. In fact, 



I have encountered such sentiments in 
my interactions with doctors as a stu- 
dent. Hence, I would like to urge 
strongly that efforts be increased to 
educate faculty and students at HMS 
about issues concerning diversity. 
Anne Su 'pp 

Setting the Record Straight 

Dr. William Campbell's ('38) criticism 
of the admissions policy of HMS was a 
bit harsh. We are indeed committed to 
the enrollment of a diverse body of tal- 
ented students who will reflect the 
character of the American people 
whose health needs we all must serve. 
Having said that, alumni should know 
that our procedures are gender bhnd 
and merit rules. The students that 
we select have stunning records of 
academic achievement coupled with 
impressive human qualities and soci- 
etal concerns. Indeed, there is diversity 
of gender, ethnicity and background. 

A high percentage of our matricu- 
lants have already demonstrated 
outstanding scientific promise. Others 
have records of distinguished commu- 
nity service. There are increasing 
numbers of somewhat older, non-tra- 
ditional students who bring with them 
life experiences and a level of maturity 
that add leavening to a class. 

Our students truly enrich us by 
their presence. I recently received a 
letter from one of our senior faculty 
who has been teaching for many years. 
He wrote to congratulate the 
Admissions Committee on having 
selected a wonderful class. He wrote, 
"What is impressive is their enthusi- 
asm about the learning process, and 
the healthy perspective they seem to 
have on medical school and how it fits 
into life. Congratulations!" 

There wasn't much diversity when 
Dr. Campbell attended HMS — nor 
was there when I did. I loved my 
years at HMS and I am proud of the 



accomplishments of my classmates. 
Nevertheless I can't help but speculate 
on how my own education might have 
been enhanced had I been exposed to 
the same diversity that our students 
are. If Dr. Campbell were a member of 
our Admissions Committee and had 
the opportunity to meet many of these 
outstanding young men and women, 
he would be as proud as I am of our 
students and would be as confident as I 
am about their future careers as physi- 
cians and alums of HMS. They deserve 
more, not less, of our support. 

Gerald S. Foster 'yi 

Faculty Associate Dean for Admissions 

I am a member of the Class of '99 and 
an American-born white male. My 
class is over half women — and many 
of my classmates have ethnic back- 
grounds. I wouldn't have it any other 
way. All people, and especially doctors, 
need to stop looking at skin and treat 
people as individuals. 

Our country is, thankfully, half 
women. In America there are Latinos, 
African Americans, Native Americans, 
Europeans, Indians, Russians, Arabs, 
and Asians, to name but a few. This 
ought to be reflected in our medical 
school class. The fact that affirmative 
action is needed to ensure this is only 
testimony to the oppressive behavior 
of whites in this country's history. 

History cannot be changed, but it 
can be accepted honestly. White 
Europeans were and still are guests in 
this land who took advantage of their 
hosts' hospitality. Above all, we must 
respect each other for our differences 
and not just our similarities. 

Dimitri Cassimatis '99 



Summer 1996 



Pulse 



Dean Tosteson to Step Down Next Year 

Daniel C. Tosteson '49 will spend his 
last year as dean of Harvard Medical 
School completing projects that will 
culminate 20 years of leadership that 
have overseen a dramatic change in the 
way medicine is taught. He will pass 
the torch next June 1997 as Robert 
Ebert did to him in 1977, as George 
Packer Berry did to him in 1965, and 
on back to the first dean of Harvard 
Medical School. 

"Dean Tosteson has served the 
Harvard Medical School, and the 
larger university community, with 
the greatest possible distinction and 
dedication," said Neil Rudenstine, 
president of Harvard University, after 
Dean Tosteson announced his inten- 
tion to retire at a specially held Faculty 
Council meeting in May. "He has 
affirmed the highest standards of 
quahty in both medical education and 
research, not only for Harvard, but for 



the nation as a whole." 

Rudenstine cited the New Pathway 
program Tosteson "ushered in" as a 
pioneering effort in the education of 
physicians, and particularly high- 
lighted his efforts to reinforce the 
connections between basic science 
and clinical research, and to recruit 
an extraordinary faculty and create 
an environment in which their 
talents could thrive. "He has worked 
vigorously in a time of constrained 
resources to keep the medical school 
on a sound financial footing and 
to revitalize the school's physical 
facihties." 

Tosteson, who graduated from 
Harvard College in 1944 and HMS in 
1949, began his academic career in 
1958 as associate professor of physiol- 
ogy at Washington University School 
of Medicine. Four years later he was 
chairman of physiology at Duke, and 
in 1975 was appointed dean of the 



Pritzker School of Medicine at the 
University of Chicago, where he 
served for two years before responding 
to the call to return to Harvard. 

The Association of American 
Medical Colleges, in bestowing upon 
Tosteson its highest honor, the 
Abraham Flexner Award, in 1991 
cited his development of "innovative 
curriculum, creating a vibrant and 
dynamic environment in the class- 
room, the laboratory, the hospital and 
the clinic." The award also credited 
him for estabhshing a division of 
medical ethics and a department of 
social medicine, and for encouraging 
extracurricular activities that "reflect 
social concerns and that give service 
beyond the traditional clinical 
boundaries." 

Other laudatory remarks were 
made when Tosteson received an 
honorary Doctor of Human Letters 
degree in 1993 from Johns Hopkins 



President Rudenstine and 
the HMS Faculty Council 
applaud Dean Tosteson 
as he announces his 
intentions. 




Harvard Medical Alumni Bulletin 



School of Medicine Dean Michael 
Johns: "You are known among deans 
of American medical schools as the 
leader of medical education... you have 
transformed medical education in the 
United States. You brought about this 
revolution by putting education first at 
Harvard, at a time when training 
young doctors often was a lower prior- 
ity than promoting research or cutting 
costs for patient care. Your enthusiasm 
inspired your faculty to rededicate 
themselves for physician training, and 
your example stimulated other medical 
schools to examine their objectives and 
their training process." 

Under Tosteson's leadership, 
research also grew at HMS. Federal 
research grants to the Quadrangle- 
based faculty alone increased from $38 
million to $85 million annually. The 
number of doctoral students in the 
core science departments has increased 
from 150 to nearly 500 the past 19 
years. And the school's endowment has 
grown from $138 million to more than 
$840 million. 

But, as Rudenstine said following 
Tosteson's announcement, "there vidll 
be many opportunities in the coming 
year to celebrate Dan Tosteson's 
extraordinary tenure as dean." In the 
meantime, a nationwide search for a 
successor is imder way. By next June, 
Tosteson says he will be ready to pass 
the torch to the next dean, "in a 
sequence that has endured for 2 14 
years, and I hope will never end." 



To: Harvard Medical School Community 

As announced earlier this month, Daniel Tosteson intends to step down as Dean 
of the Faculty of Medicine at the end of the 1996-97 academic year, having com- 
pleted 20 years of distinguished service as Dean. All of us at Harvard, and in the 
medical community beyond Harvard, are deeply indebted to Dean Tosteson for 
his remarkable contributions to the advancement of medicine — ^which will con- 
tinue vigorously through the final year of his deanship and beyond. It will be a 
considerable challenge to identify a worthy successor. 

In beginning the search for a new Dean, I am forming a faculty advisory 
group to assist me, as I have done in the case of comparable searches. The mem- 
bers of the group — 15 faculty drawn from both the Quadrangle-based depart- 
ments and a number of the Harvard-affiliated institutions — will consult with me 
closely throughout the process. Meanwhile, I am eager to have advice from the 
broadest possible range of faculty, students, staff, alumni, and others in the 
Harvard medical community, and from the larger medical education and research 
community as well. 

I invite you to write me — in confidence — with your views concerning this 
important transition. I would greatiy appreciate your thoughts on the directions 
in which Harvard medical education and research should move in the years 
ahead; the most important qualities that you believe are essential in a new Dean; 
and any suggestions that you might have regarding possible candidates. Letters, 
marked confidential, should be addressed to me, care of Marc Goodheart, Special 
Assistant to the President, Massachusetts Hall, Harvard University, Cambridge, 
Massachusetts 02 1 38. 

Many thanks for your help, and all best wishes. 

Neil L. Rudenstine 
May 31, 1996 



Summer 1996 



Pulse 



Lead Linked to Hypertension and 
Kidney Dysfunction 

Exposure to lead may be a cause of 
hypertension and kidney problems 
in adults, according to two studies 
published in the April 1 7 issue of the 
Journal of the A?7ierican Medical 
Association by Harvard researchers. 

From 1 99 1 to 1994, researchers at 
Channing Laboratory compared blood 
pressure measurements with lead levels 
in the kneecaps and tibias of 590 men 
aged 48 to 90. Hypertension was asso- 
ciated with higher levels of lead found 
in the bone. Howard Hu, lead author 
of the hypertension study, believes that 
lead may be one explanation for the 
increases in blood pressure that 
accompany aging, and notes that infor- 
mation on long-term lead exposure 
can be best obtained by measuring 
levels in bone. Hu is associate profes- 
sor of occupational medicine at the 
Harvard School of PubUc Health and 
HMS assistant professor of medicine. 

The implications of these findings 
may lead to new drug therapy for 
hypertension, Hu says. "If lead is 
shown to be a major cause of hj/perten- 
sion in some people, there may be a 
way to neutralize it in the body. Instead 
of taking drugs all their lives, perhaps 
such people could have lead in their 
bones neutralized once and for all." 

For the study on kidney function, 
the same research team led by Rokho 
Kim, HMS instructor, measured lead 
levels in the bone and blood of 459 
men over a 15-year period, although 
only the blood samples have been 
studied at this point. Men who had the 
highest levels of lead in their blood 
had more kidney damage with aging 
than those with lower levels. 
Creatinine measurements were taken 
to assess kidney function, and as Hu 
notes, "Inability to excrete creatinine 
increases with age in both men 
and women. Other factors, such as 



Steven Hyman 



diabetes, add to this loss of function. 
On top of that, lead can apparently 
make things even worse." 

Although the campaign to reduce 
lead in gasoline, canned foods and the | 
like that began in the 1970s has been 2 
successful, the authors of both studies ^1 
believe their results indicate a need for o 
more reductions. "Allowable levels of =■ 
lead exposure are four times greater 
for adults than for children," Hu says. 
"Our research indicates such standards 
may allow for a buildup to levels that 
cause an increased risk of disease and 
death. Therefore, we recommend 
that exposure levels for the general 
population be revised downward." 

Both studies were conducted as 
part of a long-term research project 
on aging which began in 1 96 1 by the 
Department of Veterans Affairs. 




Hyman Accepts Post at NIMH 

Steven E. Hyman '80, former director 
of the Harvard University Interfaculty 
Initiative on Mind/Brain/Behavior and 
associate professor of psychiatry at 
HMS, began his tenure as director of 
the National Institute of Mental 
Health on April 15. Hyman, a leading 
researcher on the biological origins 
of mental disorders, was also director 
of research in the Department of 
Psychiatry at Massachusetts General 
Hospital. He had been at Harvard for 
20 years. 

Harold Varmus, director of 
National Institutes of Health, said 
about Hyman's appointment: "Dr. 
Hyman's basic research accomplish- 
ments coupled with his clinical exper- 
tise provide a superb combination for 
guiding development of innovative 
approaches to improve care." 

At NIMH, Hyman directs a staff of 
close to 900 with a budget of over 
$600 milhon. Upon the announcement 
of his appointment, Hyman stated, 
"I am proud to be joining an institute 
dedicated to translating scientific 
advances into new hope for the one in 
every five Americans who suffer fi-om 
mental illnesses." 



Harvard Medical Alumni Bulletin 



Braunwald Named to New Post 

Eugene Braunwald, Hersey Professor 
of the Theory and Practice of 
Medicine, will take on a new role as 
HMS faculty dean for academic pro- 
grams for Partners HealthCare 
System, the corporation formed when 
Brigham and Women's Hospital and 
Massachusetts General Hospital 
merged. He will also serve as vice 
president for academic programs 
at Partners. 

"This new dual appointment goes 
a long way toward sustaining and 
strengthening academic programs of 
the Partners system and will foster 
important collaboration," says Dean 
Daniel Tosteson '49. "No one is more 
qualified than Eugene Braunwald to 
hold this post, as he is finishing a spec- 
tacular tenure as chair of medicine at 
Brigham and Women's Hospital." 
Braunwald continues as chairman of 
medicine until September when Victor 
Dzau, current chairman of medicine at 
Stanford Medical Center, takes over. 



Eugene Braunwald 




In his new roles, Braunwald will 
develop the guiding research strategy 
for Partners and work with department 
heads to promote the educational and 
research activities of HMS faculty at the 
Brigham and MGH. He wall also be 
encouraging cooperative research pro- 
grams among BWH-MGH faculty and 
other HMS investigators, particularly 
those who are Quadrangle-based. 

"The most precious asset by far of 
the Parmers research effort is the cre- 
ativity, dedication and entrepreneurial 
spirit of its scientists," notes Braunwald. 
"We must now optimize this asset by 
actively encouraging the development 
of joint research and training efforts." 



Student Debt Concerns 

Alumni, faculty, administrators and 
particularly the students of Harvard 
Medical School have been increasingly 
concerned about the magnitude of 
debt with which students are graduat- 
ing. One step in the right direction 
was made in April when the Faculty 
Council approved a plan to reduce the 
size of the unit loan — the amount a 
student must borrow before being eli- 
gible for grant funding — fi-om $25,000 
to $20,000. The plan, since approved 
by the Harvard Corporation, will be 
in effect until the end of the academic 
year in 2000, and will allow time for 
the school to develop a more perma- 
nent solution. 

More and more students are 
graduating with debts of greater than 
$150,000 and are actively trying to 
heighten awareness of their plight. 
Second-year students Peter Glickman 
and Torunn Yock organized a forum 
on student debt on April 1 1 and 
invited deans Daniel Tosteson '49 and 
Daniel Federman '53. They dedicated 
it to the memory of Clifford Barger 
'43A, who had been keenly interested 
in this problem. 

Eighty students submitted personal 
statements, which were presented to 
Tosteson and Federman, and 24 of 
them got up to speak. Ann Bryant '99 
said that when choosing among med- 
ical schools, she was advised to select 
the best school and not to worry about 
the expense. "I followed this advice 
and came to Harvard, knowing that I 
was taking on a burden of great debt," 
said Bryant. "Drawn by the Harvard 
name and reputation, I gave up schol- 
arship offers from other top schools." 
She said it was a privilege to study 
medicine at Harvard, "but I have paid 
for this privilege with a debt plus 
interest of greater than $150,000 and 
true concern for my future." 



Summer 1996 



Pulse 



Many students expressed concern 
that their career options may be dic- 
tated by salary considerations. "The 
m^nh that going to Harvard would 
open the doors of opportunity may 
have been true 20 years ago and maybe 
even 5 years ago, but today it is just a 
myth," said Mayer Ezer '99, who 
anticipates a debt burden of more than 
$100,000. "While it is true that 
Harvard puts forth both great clini- 
cians and great researchers, I can only 
strive to be a great clinician because I 
can't afford to be a great researcher." 

Students also worry about whether 
HMS can continue to attract a diverse 
student body. "As past chair of the 
Third World Caucus Weekend, it was 
frustrating to see the number of 
accepted underrepresented minority 
students who loved HMS but decided 
against attending this school when 
they reahzed that going to another 
medical school would not force them 
to accrue such a large debt," pointed 
out Victoria McGee '99. 

Worried about their future fami- 
lies, the students also spoke about the 
guilt they feel about the burden they 
are often placing on their parents. 
"Because my parents' income has not 
been what we would have hoped this 
year, I am probably going to take out 
another loan of $4,000 to pay for living 
expenses through the summer," said 
Diana Graham '99. "Contemplating 
this extra loan has been a source of 
a great deal of stress, grief and guilt 
in my family. My parents feel guilty 
for not being able to provide the 
money, and I feel terribly guilty for 
needing it." 

In speaking for the many at HMS 
who have been concerned about this 
problem, Tosteson reaffirmed the 
school's commitment to improving 
financial aid and raising additional 
funds to do so. 



Match and Point 

HMS Students fared as well as ever, with 
most matching to the top programs 
they wanted, according to Edward 
Hundert '84, associate dean for stu- 
dent affairs. This year represents a 
continuation of a trend seen in recent 
years at HMS: only 80 of the 162 
students graduating this year are 
graduating "on time." About half HMS 
students now take an extra year to do 
research or community service, or to 
study internationally. 

This year there was a big increase in 
those selecting emergency medicine (10, 
up fi-om 2 in 1995). General surgery has 
been in decline since 1987 when 2 1 
selected it to this year's low of 8 
(though there was a surge in 1992 with 
2 2 students). Following a national trend, 
about half the class is at least starting 
out in internal medicine. Significandy, 
not one student is going into anesthesia, 
"an economic expression," says Daniel 
Federman '53, dean for medical educa- 
tion, who cites the lack of jobs in that 
specialty as the reason. 

The graduates and their intended 
specialties are: 



EMERGENCY MEDICINE 

Lawrence E. Bloch 

Brigham and Women's Hospital, Boston 

Lisa Maria Charles 

Harbor-UCLA Medical Center, Torrance, 

CA 

Michael C. Dyce 

Einstein/Jacobi Medical Center, Bronx, 

NV 

Michelle Amy Finkel 

Brigham and Women's Hospital, Boston 

Shawn P.W. Franklin 

Alameda County Medical Center, 

Oakland, CA 

Brent 0. Hale 

University of Oklahoma College of 

Medicine, Oklahoma City 

Joshua M. Kosowsky 

University of Cincinnati Hospital, OH 

Kendall W. Lee 

McGaw Medical Center, NWU, Chicago, IL 

David E. Munoz 

Harbor-UCLA Medical Center, Torrance, 

CA 

Mark J. Sagarin 

Brigham and Women's, Boston 




ID 



Harvard Medical Alumni Bulletin 



FAMILY MEDICINE 
James P. MacDonald 
Maine-Dartmouth Family Practice, 
Augusta, ME 

Starie Lynn Seay 

Maine-Dartmouth Family Practice, 
Augusta, ME 

INTERNAL MEDICINE 

Colleen L. Bailey 

UC/San Diego Medical Center, CA 




Ruth M. Belin 

Hospital University of Pennsylvania, 

Philadelphia 

Monica S. Bettadapur 

Hospital University of Pennsylvania, 

Philadelphia 

Gloria G. Carreon 

Stanford Health Service, California 

Lynette P. Davenport 
Cleveland Clinic, Ohio 

Michael B. Fessler 
Massachusetts General Hospital 

Bernard M. Fine 

Stanford Health Service, CA 

Nicholas F. Fleming 
Massachusetts General Hospital 

Jan 0. Friedrich 
University of Toronto 

Monica Gandhi 
UCSF, California 

Sina A. Gharib 

Unhrersity of Washington Affiliated 

Hospital, Seattle 

Elizabeth A. Hagen 

University of Texas, SW Medical School, 

Dallas 

Christopher M. Haqq 
UCSF, CA 

Vincent T.V. Ho 

Brigham and Women's, Boston 

Elbert S. Huang 

Stanford Health Service, CA 

Kraig S. Kinchen 

Johns Hopkins Hospital, Baltimore, MD 

Raphael J. Landovitz 
Brigham and Women's, Boston 



Laura Mauri 

Brigham and Women's, Boston 

Lawrence M. McGlynn 
St. Vincent's Hospttal, NY 

Doreen A. Mensah 
Massachusetts General Hospital 

David J. Milan 

Brigham and Women's, Boston 

Hidyatullah G. Munshi 

University of Washington Affiliated 

Hospital, Seattle 

Jeff A. Odiet 

Beth Israel Hospital, Eloston 

Sanjay R. Patel 

Hospital of University of Pennsylvania, 

Philadelphia 

Venkatesh K. Raman 
Brigham and Women's, Boston 

Sarathchandra I. Reddy 
Brigham and Women's, Boston 

Lawrence R. Sanders 
Stanford Health Service, CA 

Manish A Shah 

Duke University Medical Center, Durham, 

NC 

Lisa Y. Shieh 

Stanford Health Service, CA 

Nona Sotoodehnia 

University of Washington Affiliated 

Hospital, Seattle 

Annie Y. Suh 

Harbor-UCLA Medical Center, CA 

Shelley L. Sylvester 

Brigham and Women's, Boston 

Wai H.W. Tang 

Stanford Health Service, CA 



Nancy W.H. Tseng 

Kaiser Permanente, Oakland, CA 

Theodore Tsomides 

Maine Medical Center, Portland 

Thomas Minh Tu 
Massachusetts General Hospital 

Jesus M. Valadez-Herrera 
Harbor-UCLA Medical Center, Torrance, 
CA 

Thomas J.F. Wang 
Massachusetts General Hospital 

William P. Warren 
Massachusetts General Hospital 

Howard L. West 

Brigham and Women's, Boston 

Stephen D. Wiviott 

Brigham and Women's, Boston 

Yinlee Yoong 

Mayo Graduate School of Medicine, 

Rochester, MN 

MEDICINE/PEDIATRICS 

Naomi N. Duke 

University of Michigan Hospitals, Ann 

Arbor 

Emily Oken 

Harvard Combined Medical Program, 

Boston 

Venus I. Pitts 

Duke University Medical Center, Durham 

Sonja S. Short 

University of Minnesota Hospital 

NEUROLOGY 
Asa Abeliovich 
UCSF, CA 

Andrew H. Ahn 
UCSF, CA 



NEUROSURGERY 

Rafael Allende 

Strong Memorial Hospital, Rochester, NY 

Bozena R. Jachna 

Brigham and Women's, Boston 

Paul S. Jackson 

Brigham and Women's, Boston 

Wendy J. Spangler 

Barrow Neurology Institute, Phoenix, AZ 

OB/GYN 

Melissa C. Bush 

UCLA Medical Center, CA 

Diana P. Carmona, 

Sinai Hospital, Baltimore, MD 

Deborath L. Cohan 
UCSF, CA 

Eleanor A. Drey 
UCSF, CA 

Keri K. Gardner 

University of Colorado School of 

Medicine, Denver 

Thomas F. McElrath 
Brigham and Women's, Boston 

Georgia S. Vasilakis 

Brigham and Women's, Boston 

Alice C. Vincent 

Brigham and Women's, Boston 

Tutasi K. Waters 

Flushing Hospital Medical Center, NY 

Jacqueline D. White 

Rush Presbyterian St. Lukes, Chicago 

OPHTHALMOLOGY 

Paul H. Chen 

University of California, San Francisco 

Michael F. Chiang 

Johns Hopkins University Program 



Summer 1996 



II 



l' 




Pulse 


mBL^] 




Mr - -^ 


Stella K. Kim 
Massachusetts Eye and Ear 




Anil U. Swami |^ 
Baylor College of Medicine Program, ^ 
Houston H 




1 


ORAL SURGERY H 
Jonathan S. Bailey H 
Massachusetts General Hospital ^M 


^K 


^^H 



•>-s 



n'S 



Mark D. Zajkowski 
Massachusetts General Hospital 

ORTHOPEDIC SURGERY 

Nicholas U. Ahn 

Johns Hopkins Hospital, Baltimore 

Scott I. Berkenblit 

Johns Hopkins Hospital, BaHimore 

Domingo Cheleuitte 

Harvard Combined Orthopedic Program 

Kingsley R. Chin 

Harvard Combined Orthopedic Program 

Choll W. Kim 

University of California, San Diego 

Medical Center 

Arun J. Ramappa 

Harvard Combined Orthopedic Program 

Edward C.Y. Sun 

UCLA Medical Center, San Francisco 



OTOLARYNGOLOGY 

Camille A. Graham 

Henry Ford Hospital, Detroit 

Timothy E. Hullar 

Johns Hopkins Hospital, Baltimore 

Pratik S. Pradhan 
Massachusetts Eye and Ear 

Traci L. Vaughan 
Cleveland Clinic, Ohio 

PATHOLOGY 

Anthony C. Forster 

Brigham and Women's, Boston 

Jae K. Joung 

Massachusetts General Hospital 

Margaret E. McLaughlin 
Brigham and Women's, Boston 



Peter J. Tontonoz 

University of California San Diego 

Medical Center 

Tad J. Wieczorek 

Brigham and Women's, Boston 

Rhonda K. Yantiss 
Massachusetts General HospKal 

PEDIATRICS 

Louis P. Appel 

University of Washington Affiliated, 

Seattle 

Ann T. Bramlage 

University of Washington Affiliated, 

Seattle 

David W. Brown 
Children's Hospital, Boston 





y 



Paul J. Chung 
UCLA Medical Center 

Colleen S. Delaney 

University of California, San Francisco 

Beth E. Ebel 

Johns Hopkins Hospital 

Deborah R. Hoffer 

University of Washington Affiliated, 

Seattle 

Douglas P. Jutte 

Stanford Health Service, California 

Lydia Ko 

Johns Hopkins Hospital, Baltimore 

Andrew Y. Koh 
Children's Hospital, Boston 

Judith B Romero 
Massachusetts General Hospital 

Michael A. Ruiz 

Children's Hospital, Oakland, California 

Joshua M. Sharfstein 
Boston City Hospital 

Kimberly Stegmaier 
Children's Hospital, Boston 

Christopher Stewart 
UCSF, CA 

Chih-Hung J. Wang 
UCSF, CA 

Janine Young 
Boston City Hospital 

PLASTIC SURGERY 
Alexander K. Arrow 
UCLA Medical Center 

Shalini Gupta 

Rhode Island Hospital, Providence 

David L. Kaufman 
Stanford Health Services 



12 



ELvRVARD Medical Alumni Bulletin 



Albert Losken 

Emory University School of Medicine, 

Atlanta 

PRELIMINARY MEDICINE 

Manish S. Bhandari 

Rhode Island Hospital, Providence 

Jocelyn S. Dee 

St. Mary Medical Center, Long Beach, CA 

Edmund Lee 

Rhode Island Hospital, Providence 

Edwin P. Perez 

Stanford Health Services, Califomia 

PRIMARY CARE 

Anna Berkenblit 

Brigham and Women's, Boston 

Charlene M. Chiang 

Mt. Auburn Hospital, Cambridge, MA 

Ben Gavi 

Brigham and Women's, Boston 

Thomas A. Gaziano 

Brigham and Women's, Boston 

Andrew J. Greenspan 
New York Hospital, NY 

Kamala B. Jain 

Unwersity of California, San Francisco 

Rajani C.N. LaRocca 
Massachusetts General Hospital 

Patricia K. Lee 

New York University Medical Center, NY 

Edward L. Machtinger 

University of California, San Francisco 

Benjamin L. Sapers 

Brigham and Women's, Boston 

Jeffrey L. Schnipper 
Massachusetts General Hospital 

Ann C. Smith 

Brigham and Women's, Boston 

Rahel Teferi 

Alameda County Medical Center, 

Oakland, CA 

PSYCHIATRY 

Judith G. Edersheim 

Cambridge Hospital, Massachusetts 

Juliana I. Ekong 
Presbyterian Hospital, NY 




Ann G Hess 

Harvard Longwood Psychiatric, Boston 

Marcia L Zuckerman 

Harvard Longwood Psychiatric, Boston 

RADIOLOGY 

Sandip Biswal 

Stanford Health Services, California 

Jerold L. Boxerman 

Johns Hopkins Hospital, Baltimore 

Timothy L. Davis 
Barnes Hospital, St. Louis 

Philip G. Jeffrey 

New York University Medical Center, NY 

Linh U. Le 

University of California, San Francisco 

Patrick J. Ledden 
Massachusetts General Hospital 

SURGERY 

Jennifer C. Hirsch 

University of Michigan Hospitals, Ann 

Arbor 

B. Price Kerfoot 

Brigham and Women's, Boston 

Laura A. Lambert 
Dartmouth-Hitchcock, Hanover, NH 

Donna-Marie Manasseh 
Presbyterian Hospital, NY 

Carmen Ruiz 

Boston University School of Medicine 

Antonia E. Stephen 
Massachusetts General Hospital 



Seth M. Weinreb 

Emory University School of Medicine, 

Atlanta 

Angela V. Wong 

Cedars Sinai Medical Center, Los Angeles 

OTHER 

Neal A. Baer 

Screen Writer, "E.R.", Los Angeles 

Adam M. Brook 

Graduate PhD Candidate, BBS Program, 

Harvard Division of Medical Science 

David Chan 

Research Fellowship, Whitehead 

Institute, Cambridge, MA 

Anna Kazanchyan 
Biotechnology, Boston 

Daniel K. Sodickson 
Research Fellowship, Boston 

Erich C. Strauss 

Research Fellowship, Mayo Clinic, 

Scottsdale, Arizona 



Summer 1996 



13 



On the Quad 



A Case for Countway 

If a professorship at HAIS were pro- 
posed in honor of someone who had 
been your beloved teacher, a caring 
physician, an effective innovator... 

If you knew that an HMS scientist 
had demonstrated that a specific pep- 
tide-receptor interaction was required 
for invasion by viruses, had isolated 
and sequenced the peptide, had charac- 
terized its interaction with the recep- 
tor, and had created a modified peptide 
that could block viral invasion... 

If you knew that a surgeon in an 
HMS-associated hospital was about to 
cure diabetes in humans by transplant- 
ing tissue from animals that had been 
made histocompatible by genetic 
engineering... 

If you knew that a medical student 
from an impoverished background 



would be unable to continue with 
important research at HMS without 
some financial help. ..would you 
contribute? 

Scenarios like these have occurred, 
and will occur again, in HMS and its 
associated hospitals. The record shows 
that we HMS alumni do indeed con- 
tribute. In contrast — who ever heard 
of an exciting let alone inspiring 
library? It has been much more diffi- 
cult to enlist fund support for 
Countway 's current $io million capital 
fund drive, but its pressing needs may 
indeed be related to scenarios like the 
ones just described. 

Included in the planned renova- 
tions for Countway: 

• Rare books and archives: 
Controlled environmental conditions 



and adequate shelf and cabinet space 
are necessary for the two centuries of 
collected rare books and manuscripts. 

• A reading room that keeps all cur- 
rent issues of intensively used journals 
secure, intact and immediately accessi- 
ble, and provides ample electronic 
equipment for bibliographic search. 

• Knowledge Laboratory: an interac- 
tive facility that will provide fully- 
equipped electronic classrooms, the 
most advanced computers and learning 
technologies together with the services 
of a knowledgeable staff. 

That hypothetical beloved physi- 
cian for whom a professorship has 
been named has also left his papers in 
the care of the Countway Library. It 




"2 'f, i.'rj ^jlf'' 



14 



Harvard Medical Alumni Bulletin 



costs money to process and store them 
for a biographer's future use. That 
h)q)othetical peptide-receptor scientist 
learned to model protein-protein 
interactions in the Knowledge 
Laboratory of the Countway Library, 
and carried out critical steps of her 
work there. The HMS surgeon's work 
depended upon research using the 
Countway Library's immunological 
and genetic databases. And the medical 
student would not have been able to 
do the assignments, let alone the 
research, without frequent access to 
the Countway Library. 

Though the facts make the 
Countway seem impersonal and irrele- 
vant, they too are impressive: 608,843 
volumes stored; 686,920 volumes 
circulated last year; 3,971 journals 
subscribed to; users (Harvard, Boston 
University, Tufts, Massachusetts 
Medical Society, many others) make 
1,000 visits a day, and, just in the last 
year, asked 48,672 questions of the 
reference librarian, browsed through 
6,590,213 citations on the library's 
multiple computerized databases, and 
photocopied 4,009,668 pages. 

We should remember that all of the 
figures convey two very human facts: a 
vast number of people, working all 
over the world, year after year, have 
contributed their data and their 
thoughts in the form of books and 
journals so that others, unseen and 
unknown, can use them, reinterpret 
them, build on them. The second fact 
is that vast numbers of people seek 
those thoughts and those data: care- 
givers, researchers and historians. 

The library is the marketplace 
where all this occurs. Every day, fresh 
data, fresh ideas — who knows for sure 
which ones? — may lead to new thera- 
pies, even new specialties. Data from 
ancient manuscripts on herbal medi- 
cine may lead to the cure of previously 
incurable diseases. In the hands of 



historians the men of old may be cast 
down from their seats, while the hum- 
ble are exalted. The library is a coun- 
try with only a few busy intersections 
in the midst of vast jungles and deserts 
where a few prospectors and hunters 
wander alone. 

You can also learn a lot more 
about it by going to the website that 
Countway librarians prepared for HMS 
(htpp://www.med. harvard.edu). There 
you can reach: the Countway Express 
Retrieve and Copy Service; online 
publications from the Harvard 
Medical Area (full text of this maga- 
zine is there, along with Focus, the 
newsletter of HMS, Harvard Health 
publications, the Whole Brain Atlas, 
and more). You can use Countway 
Plus/Ovid to search Medline and other 
databases, access their Web jewels, and 
much, much more. 

Finally, attention should be paid to 
the Countway Library building itself, 
and not just that it is a building of 8 
stories and 140,000 square feet. The 
architect, Hugh Stubbins, could not 
anticipate rising energy costs, the need 
for climate control, and the extensive 
wiring required for electronic 
equipment. 

He did, however, create a temple of 
learning whose great serene spaces 
have never been more appreciated 
than now, as we move into an age of 
more compact offices with fewer win- 
dows. Unquestionably, for some, its 
highest function is as a place of medi- 
tation and contemplation. 

George Richardson '^6 



International Partners 

A scant 1 8 months in existence. 
Harvard Medical International has 
found a ready, willing and able inter- 
national market to sell its "wares." 
Formed to develop and market pro- 
grams in medical education, research 
and clinical care, HMI already is negoti- 
ating or conducting uniquely tailored 
programs in about 20 countries around 
the world. In just the past several 
months, HMI has announced inter- 
institutional alliances with the Asan 
Medical Center in Korea and with the 
Rangsit University in Thailand. 

"We have found that there is a 
pent-up need for what we have to 
offer," says Robert K. Crone, MD, 
president and CEO of HMI, HMS clinical 
professor of anesthesiology, and dean 
for international programs. "There is a 
worldwide recognition of what quality 
is and that high-quality health care 
must be made available." The 
economies of emerging nations are 
improving, he adds, and in countries 
where health care traditionally has 
been provided "free," there is a need 
for new models to provide a higher 
standard of health care. 

Harvard Medical School brings 
quality, legitimacy, comfort and name 
recognition. "As I go around the 
world," he quips, "Coca-Cola and 
Harvard are the two most recognized 
American names." 

As with any business venture, HMI 
has product lines, offering the follow- 
ing five services that can be tailored to 
the needs of its international clients: 

• health care facility development 
and management (feasibility and analy- 
sis demand studies; costs estimation, 
revenue potential; project planning, 
financing, development and commis- 
sioning; the provision of management 
services and systems; and clinical 
staffing and leadership); 



Summer 1996 



15 



On the Quad 



• educational products and services 
(continuing medical education pro- 
grams, scholar exchange programs, a 
CD-ROM library of medical texts and 
periodicals that is under development, 
medical education curriculum design 
consulting, and international versions 
of the Harvard health letters); 

• research services (the development 
of clinical research facilities, laborato- 
ries or training programs); 

• consultative services (on all above 
areas, plus health care policy, quality 
assurance, service delivery systems, 
practice plan development, disease 
management, telemedicine and med- 
ical library services); and 

• patient care referral and access (to 
tertiary care at Harvard-affiliated hos- 
pitals; eventually to care from a net- 
work of Harvard-associated hospitals 
around the world). 

Make no bones about it. Harvard 
Medical International was formed, in 
part, to make money for HMS — and it 
has already — but its long-range goals 
are in fact much loftier. "If we are suc- 
cessful in our global strategy, we have 
the opportunity to elevate the standard 
of health care throughout the world," 
says Crone. The global strategy is to 
create a network of Harvard-quality 
institutions in strategic locations, 
linked by the "common language of 
instruction, a common medical 
education curriculum, clinical care 
protocols, and the common aims 
(methodology, ethics) of research, with 
Harvard faculty flowing freely within 
the network and Harvard medical 
students doing rotations." 

Therein lies another benefit, 
besides supporting the medical school 
programmatically and monetarily, of 
this vision. "Dean Tosteson also saw 




this as an opportunity, at a time when 
medicine here in the United States has 
reached a plateau and the number of 
specialists needed is declining, to use 
our vast resources in the faculty with- 
out their having to leave." Crone's 
motivation is to accompHsh this so 
everyone benefits and the state of 
health care and medical education is 
improved worldwide. 

Crone came to this position from 
Project HOPE, where he was a senior 
vice president for medical operations, 
handling negotiations with foreign 
governments and institutions. (He had 
previously been professor of anesthesi- 
ology and pediatrics at the University 
of Washington School of Medicine 
and before that, a member of the HMS 
faculty and director of the intensive 
care unit at Boston's Children's 
Hospital.) 

"I'd rather see health care dollars 
spent on institutions that serve as an 
example and magnet in specific regions 
than to work top down on raising the 
standards of health care through agen- 
cies like the World Health Organi- 
zation," he argues. "Working in the 
international health community, I saw 
billions of dollars spent on trying to 
shape health policy largely through 
highly-paid, uncommitted consultants 
who come and go." 

Both approaches are needed, he 
acknowledges, " but I am a practical 
person. There is a global need to 
improve health care services, but in 
reality everything has a cost. 



Sustainable sources of finding must be 
identified and used in the most cost- 
effective manner available. There are 
real opportunities to link less remu- 
nerative but more cost-effective public 
health initiatives with top-quahty 
treatment centers when facilities and 
programs are planned together. As 
examples, clinical laboratory services 
can also provide clinical epidemiology 
surveillance for a region and blood 
banks can serve as regional centers 
for AIDS diagnosis, counseling and 
treatment." 

One of the most important things 
he says he has learned by working out- 
side of the United States is: "Nothing 
can be imposed upon another country 
without their wholehearted embrace. 
We're not so arrogant as to believe that 
we know what is good for them. We're 
there to provide guidance and support, 
but only in a partnership with the local 
medical and business commimities." 

Wherever they have a program, 
they find a local partner — a commu- 
nity group, business, or university — 
who underwrites or invests in the 
project, usually with the support and 
cooperation of the governments and 
their ministries of health. As word has 
gotten out about HMI, many groups 
have come to them. "We have had to 
find legitimate ways to evaluate 
requests to see which make sense for 
us to take on," says Crone, "in terms 
of programmatic sense for that partic- 
ular community and good business 
sense, in that it could be viable, long 
term and self-sustaining." 

People often ask Crone what HMI is 
doing about Africa and other countries 
that can't afford direly-needed health 
care. "I'm upfront that this is a busi- 
ness venture, not philanthropy. We 
have to be on sound economic footing 
before we can take on projects that 
could jeopardize the organization's 
ability to survive." 



i6 



Harvard Medical Alumni Bulletin 



Even when they get to this point, 
says Crone, "we will insist that 
everything we do is self-sustaining. 
Hand-outs just don't work in my 
experience." He says that his greatest 
frustration at Project HOPE was that 
very often, when the government 
grants went away, so did the programs. 
"We have to find a continuing, renew- 
able approach. Putting something on a 
sound business footing does not mean 
it is exploitive. It makes sense for the 
long haul." 

Taking on projects that have 
potential to enrich the Harvard med- 
ical community also means to Crone 
that they hope to learn from their 
partners in other countries how to 
proAdde health care in culturally sensi- 
tive and cost-effective ways. For 
example, in India, though there's a 
burgeoning middle class of 300 million 
people, locally defined this is anyone 
who makes more than $350 a year. 
How do you provide health care in 
that economic environment? "We are 
hoping to help develop a self-sustain- 
ing model of health care delivery 
with groups in India who are trying to 
answer this question. We believe that 
we will be learning from them through 
this linkage, just as they will benefit 
from an enhanced standard of 
health care." 

There is intense oversight of HMI 
to ensure that it embraces the ethics, 
traditions and mission of the medical 
school and the university as it pursues 
its more business-oriented ventures. 
Crone reports to a board comprised of 
senior leadership of the medical school, 
members of the university's corpora- 
tion, and outside members "with a 
vision of the world community." 

Alumni of the medical school and 
of residency training programs resid- 
ing internationally have been used as 
advocates and sources of local infor- 
mation and counsel. Harvard Business 



School graduates, who are often the 
leaders of business communities 
around the world, have helped facili- 
tate understanding of regional business 
practices. And Crone has also sought 
out Harvard faculty experts on various 
regions of the world and links with 
other university international pro- 
grams where possible. 

There is an academic veneer to this 
business, but it is being run like a busi- 
ness with a bottom line like a business. 
Crone is purposefully trying to keep 
the number of executives and consul- 
tants on staff relatively small — there 
are about eight others now — by bring- 
ing on additional staff for particular 
projects as they are funded. He wants 
to keep the infrastructure lean and 
cost effective. 

Many HMS faculty have already 
been sent to the Asian Pacific, Middle 
East and South America on the various 
projects. Crone himself spends half 
his time overseas. In one two-week 
period, for example, he had been to 
India, Singapore and the United 
Kingdom. Though realization of the 
vision of a global network may be 10 
to 20 years away, people seem to be 
listening to his message that "good 
health is good business." 

Ellen Barlow 



LEFT BANK 

We offer rental of our spacious, 

well-appointed 17th century 

apartment home. The period 

decor includes all modern 

conveniences. The location is the 

finest in Paris, on the Rue de 

Varenne, 7th Arrondissement. 

Maid service and our Guide to the 

Best of Paris are included for free. 



ST„ BARTS 



We offer rental of our wonderful 

home on the ideal tropical island. 

Our spacious property has a private 

pool and is carefully-tended, 

perfect for honeymoons and 

relaxing vacations. Maid service 

and our Guide to the Best of St. 
Barts are included free of charge. 

(415.) 327=2415 

Please call for further particulars. 
It will be a pleasure to assist you. 



Summer 1996 



17 



Book Marks 



Genes, Blood and Courage: 
A Boy C.\lled Immortal Sword 
by David G. Nathan, md 
Belknap Press of Harvard 
University Press 
London, England, 1995 

by Elissa Ely 

Years ago, I rotated through a pedi- 
atric clerkship at Children's Hospital, 
and met a 14-year-old girl with end- 
stage chronic active hepatitis. She was 
a tired, plump, passive girl who spent 
her days in a corner bed that had no 
cards or chocolates. Her father had 
skipped town, and her mother wafted 
in and out of her life as she chose 
(which, I realize now, was as much 
as she could bear). On this admission, 
besides the traditional right-upper- 
quadrant pain, Marquise had new- 
onset hematemesis. She lay in bed 
with a tube down her tmhappy nose. 

One night after visiting hours were 
over, I was drawing blood when the 
door banged open, and a svelte, char- 
coal woman swirled in. Her arms were 
filled with baskets and stuffed bears, 
and she smelled of alcohol. She buried 
her head dramatically in Marquise's 
uncomfortable neck, and held it there 
too long. Then she raised it, saw my 
white coat, and drew herself up. 

"I want you to know," she said, in 
an elegant slur, "that we are TIRED of 
these liver pills. Even though we're 
on welfare, I want you to know we've 
got the money and the power, AND 
Mohammed. I want a liver transplant 
for this child, doctor, and I want it 
TONIGHT." 

Years later, I understood: her 
bravura was her effort to control an 
uncontrollable situation. The angry, 
drunken, sorrowful mother of 
Marquise had the will but not the 
way to save her child. 



GENES 

BLOOD 

AND 
COURAGE 




A Boy Q,(^ed, Immortd ^uiord, 



and the depth of a bntiiant research scientisl." 
RICHARD PRKTON, author of THE HOT ZONE 



Doctors can be luckier. At the end 
of his book Genes, Blood and Courage: 
A Boy Called Immonal Sword, David 
Nathan writes, "I'm not going to let 
the rules of biology stand in my way. 
If those rules won't let me succeed, I'll 
have to invent new ones." Those are 
the kind of flamboyant, intoxicated 
words that Marquise's mother might 
have used. But Nathan — researcher, 
hematologist and HMS professor of 
pediatrics — had the way as well as 
the will. 

In 1968 he began a relationship 
that continued through four countries 
and 27 years. Dayem ("immortal 
sword" in Arabic) was the son of a 
wealthy Iranian father and a mother 
who could trace her lineage to fif- 
teenth-century Mecca. He was diag- 
nosed after birth with a heterozygous 
variant of the hereditary anemia tha- 
lassemia. By the time he was six years 
old, he had the "stature of an average 
boy of two" and "the appearance of a 
highly cerebral gargoyle." 

Genes, Blood and Courage is about 
evolutions and revolutions. When 
Dayem first arrived at Children's 
Hospital Medical Center, he had "the 
lowest hematocrit value we ever 
recorded on a patient who walked into 



the clinic on his own." Bone marrow 
transplants in 1968 carried a 75 per- 
cent chance of failure (in 1996 they 
carry a 75 percent chance of success). 
Transfusions corrected his anemia but 
left him overloaded with iron. At 16, a 
dissident adolescent, Dayem was 
forced to begin chelation therapy, 
hooked to an unwelcome holster- 
pump. ("When teenagers put it on," 
Nathan writes, "they could smell their 
own mortality.") After that there were 
unsuccessful attempts at shunts to 
make the chelation more palatable ("I 
felt that we were being closed in by the 
limits of anatomy"), refined transfu- 
sion techniques, and ten hospital 
admissions in a single year. There 
were episodes of encephafitis and heart 
failure. But always, Dayem lived. 

Each treatment decision bought 
time for research on the next. "My era 
of (research) training," Nathan writes, 
"was in the 1950s. . . [when] we were 
more akin to strip miners than to 
deep-shaft miners." As a stripminer at 
HMS in 1952 he knew only through 
Mendelian analysis that thalassemia 
was due to two defective recessive 
hemoglobin genes. 

Then in the 1970s deep-shaft min- 
ing techniques became available: 
radioactive DNA probes, restriction 
enzymes, reverse transcriptase, plas- 
mids and, most recently, polymerase 
chain reactions. Researchers — includ- 
ing Nathan and collaborators at 
Children's Hospital and Massachusetts 
Institute of Technology — were able to 
isolate, clone and sequence thalassemia 
genes. They found that the beta tha- 
lassemia defect was due to depressed 
MRNA activity — sometimes total mrna 
absence, sometimes severe MRNA 
dysfunction. 

In 1982 Nathan's laboratory pub- 
lished the definitive work on six sub- 
types of mutations affecting different 



18 



Harvard Medical Alumni Bulletin 



parts of the beta gene differently. 
These days a precise lesion can be 
detected in almost every patient, and 
prenatal detection (in combination 
with selective abortion) has rendered 
the disease preventable. "Deep-shaft 
mining" genetic techniques have 
also made it possible to prolong the 
protective powers of fetal hemoglo- 
bin — normally absent after birth — in 
thalassemia patients. Eventually, they 
may even make it possible to insert 
normal hemoglobin genes into 
stem cells before bone marrow 
transplantation. 

Reading what a researcher has writ- 
ten about his life work is like sitting 
behind a bush pilot with a lot of 
ground to cover. Nathan sets down 
briefly (and sometimes a little wildly) 
on all kinds of terrain: Darwinism and 
balanced polymorphism; the history 
of National Institutes of Health; the 
ethics of patient trials; the discovery of 
Desferal (the iron-chelating agent) in 
a fungal extract; the impact of Roe v. 
Wade on fetal research; the delicate 
relationship between pediatrician and 
parents; the "pernicious" opposition 
to recombinant DNA research that 
reached back to civil rights and 
Vietnam eras. He lands for a longer 
time (as he should, since this is his 
destination) on hemoglobin — its 
genetics, structure and "switching" 
during fetal development. 

Most importantly, in this long ride, 
he circles continuously around the 
many years of his relationship with 
Dayem: first with the child Dayem ("I 
felt I had known him for years"), then 
with the raging adolescent Dayem 
("his indolent life angered me"), and 
finally, with the grown Dayem (now 
34) who has become a successful entre- 
preneur, using a portable phone from 
his hospital room to sell bullet-proof 
limousines to buyers in the Near East. 



Over its decades this relationship per- 
suaded Nathan not to let biology stand 
in the way of treatment. 

What a researcher needs is money, 
equipment, technique and time. What 
a patient needs is care, strength, treat- 
ment and time. What they need in 
common is time, always time. 

How beautiful it is, then, when the 
researcher lives long enough to see his 
questions answered! How beautiful 
when his patient lives long enough to 
live some more! 

Elissa Ely '88 is a psychiatrist in a 
Massachusetts state institution, a commen- 
tator for NPR's ^'All Things Considered, " 
and an occasional op-ed writer for the 
Boston Globe. She is also a member of 
the editorial board of the Harvard 
Medical Alumni Bulletin. 




Summer 1996 



19 







The 

Invisible 

Mainstream 

Millions of Americans are using alternative 
therapies^ hut which ones really work and why? 



by David M. Eisenberg 



20 



Harvard Medical Alumni Bulletin 



Medical concepts and practices 
alternative to mainstream American 
medicine have gained dramatic and 
increasing public attention in recent 
years. Consumers today spend billions 
of dollars on the more commonly used 
alternative or complementary thera- 
pies, which include chiropractic, 
homeopathy, acupuncture, herbal 
remedies, meditation and dietary 
supplements. These are all medical 
techniques that doctors don't usually 
learn about in medical schools, but 
people use nonetheless for such 
major conditions as back pain, cancer, 
headache, chronic pain, addictive 
disorders and AIDS. 

About five years ago, my col- 
leagues and I set out to document the 
extent to which Americans use alterna- 
tive medical therapies. The results of 
our national survey, published in the 
January 28, 1993 New E7igla7id Journal 
ofMediciiie, raised eyebrows in both 



the medical and nonmedical commu- 
nities. For example, we found that: 

• About 60 million Americans used at 
least one alternative therapy to treat a 
serious or bothersome medical prob- 
lem during the previous year. 

• Seven of ten people who used 
alternative therapies never mentioned 
this to their medical doctors. 

• In 1990 Americans spent about $14 
billion on alternative medical thera- 
pies, $10.5 billion of which was cash 
out-of-pocket. That's almost as much 
as the $12 billion spent out-of-pocket 
on all hospitalizations that same year. 

• We estimated that over a 12 -month 
period, Americans made 425 million 
visits to offices of alternative medical 
practitioners (chiropractors, acupunc- 
turists, homeopaths, etc.). This 



exceeded the number of visits made 
that same year to all internists, family 
practitioners, GPs, gynecologists and 
pediatricians combined. 

It was as though we had discovered 
what my friend, Janis Claflin of the 
John E. Fetzer Institute (who has sup- 
ported this work), called "the invisible 
mainstream" of U.S. health care. 

A month after the survey's publica- 
tion, PBS aired the documentary series 
"Healing and the Mind widi Bill 
Moyers." The series, which looked at 
a range of alternative and mind-body 
therapies, ushered in a second wave 
of popular debate. People were asking: 
"Do alternative medical therapies 
work? Can the mind predictably alter 
the body in ways that change the 
course of health or illness?" Given 
the country's response to "Healing 
and the Mind," it was clear that tens 
of millions of Americans wanted 



Summer 1996 



21 



additional informatiion about alterna- 
tive medicine. 

Patients want to know which alter- 
native therapies may be beneficial. 
For example, a patient whose severe 
low back pain has not responded to 
medications, physical therapy, or 
surgery, wants to know if chiropractic 
will help him. A mother wants to know 
if homeopathy can possibly help her 
son whose ear infections have not 
responded to five courses of powerful 
antibiotics. Then there's your patient 
with breast cancer who wants to know 
if a macrobiotic diet is worth consider- 
ing; if acupuncture or herbs can reduce 
the side effects of chemotherapy — 
the nausea, weight loss and anemia; 
and if any of these therapies are 
potentially dangerous and therefore 
contraindicated? 

We can all think of patients for 
whom conventional medicine has been 
exhausted, whose suffering is ongoing, 
and who desperately and understand- 



My guess is that 
most of us have at 
least one friend or 
family member 
who has used an 
alternative therapy. 



ably want to know: "What else should 
I try?" My guess is that most of us 
have at least one friend or family 
member who has used an alternative 
therapy to treat a serious or bother- 
some problem. 

Shortly after the PBS series aired, 
Senator Tom Harkin, then chair of the 
Senate Health Appropriations 



Subcommittee, held a hearing in 
Washington to discuss funding for 
alternative medicine research. In 
response to constituents' demands, 
Senator Harkin and others in 
Congress requested that the National 
Institutes of Health evaluate alterna- 
tive medical therapies. Thus, the 
Office of Alternative Medicine was 
created by Congress with initial 
funding of $2 million. 

As I testified before Senator 
Harkin's subcommittee, I argued that 
we need to rigorously evaluate what 
works and what doesn't, what's toxic 
or safe, and what's beneficial. I also 
stated that research centers should be 
built in the midst of our most 
respected medical institutions to 
insure credibility and fair-mindedness. 
Today, some four years later, there are 
ten such centers funded by grants fi-om 
the nih's Office of Alternative 
Medicine. The Center for Alternative 
Medicine Research at Beth Israel 



Setting a 
New Course 



Interest in learning about alter- 
native medicine is strong 
among medical students and 
growing among older physi- 
cians, who are signing up for 
related continuing medical 
education (CME) courses at 
Harvard in record numbers. 

At least 40 U.S. medical 
schools now offer a student 
course devoted to alternative 
or complementary medicine. 
The HMS course directed 
by David Eisenbeii; '80 is 
called Alternative Medicine: 
Implications for Clinical 
Practice and Research, and 
has been offered since 1993. 
It is an elective one-month 
course that meets five days a 
week, five hours a day. 
Through a combination of case 
studies, visits from alternative 



practitioners (chiropractor, 
homeopath, acupuncturist), 
immersion in the rules of sci- 
entific evidence, and critical 
reading of the literature, stu- 
dents come to understand the 
basic theories of alternative 
therapies and current knowl- 
edge or lack thereof about 
their efficacy and mechanisms 
of action. Each student is 
required to design a prospec- 
tive, randomized controlled 
trial to critically assess an 
alternative medical therapy. 

Eisenbei^, though open- 
minded, is an advocate for 
rigorously evaluating these 
therapies. In the course, stu- 
dents are required to critique 
studies on alternative therapies 
in top-tiered journals, based on 
quality of methodology, results 
and conclusions. The goal is 
not just to regui^itate what the 
author did, but to assess 
whether the methods were suf- 
ficient to come up with the 



conclusion reached. In all 
cases they come to the conclu- 
sion that there is not enough 
evidence, points out Eisenberg. 

"By the end of this course, 
they have figured out the rules 
of evidence," he says. "They 
come up with marvelous, cre- 
ative experiments, which are 
often better designs than ever 
done. I wish I had unlimited 
funds to support some of their 
trials." 

These students, he says, will be 
intelligent, critical reviewers of 
any article about any kind of 
therapy. "They come away 
humble about how few of the 
things we practice on the 
wards have been subjected to 
this level of controlled investi- 
gation." 

The backbone of this course, 
as most other HMS courses, 
are the cases. One of the five 
cases, for example, is called 



An Odyssey of Healing: 

"Shelley Rollins, a 34-year-old 
clinical psychologist, is found 
to have stage III adenocarci- 
noma of the breast. In addition 
to lumpectomy, chemotherapy, 
radiation therapy and psy- 
chotherapy, Shelley decides to 
begin a strict macrobiotic diet. 
She also undergoes acupunc- 
ture, massage and "energy 
healing" in an effort to maxi- 
mize her health. You, her pri- 
mary care physician, are asked 
to coordinate Shelley's care." 

According to the prospectus, 
the case addresses a wide 
array of unproven cancer ther- 
apies, explores reasons 
patients use these therapies, 
and offers opportunities to 
improve interviewing skills and 
patient/doctor communica- 
tions. The students meet with 
providers, ask them questions 
and personally experience 
selected techniques. At the end 



Harvard Medical Alumni Bulletin 



Hospital, Harvard Medical School, 
last fall received an award of $935,696 
over three years to focus initially on 
alternative therapies for low back 
pain and coronary artery disease. 
Other NIH centers are based at 
Stanford University, University of 
California/Davis, Columbia 
University, Minneapolis Medical 
Research Center, University of 
Maryland School of Medicine, 
University of Texas Health Science 
Center, University of Virginia School 
of Nursing, Kessler Institute for 
Rehabilitation in New Jersey, and 
Bastyr University AIDS Research 
Center in Seattle. 

With these NIH grants, alternative 
therapies will come under the same 
scientific scrutiny and open-minded 
skepticism that has long characterized 
the finest research within conventional 
medicine. Through the development 
of methodologically rigorous and 
balanced analyses, the Beth Israel's 



Center for Alternative Medicine 
Research will neither advocate nor 
condemn alternative therapies, but 
rather seek to understand their 
usefulness or lack thereof. 

Historically practitioners of alter- 
native medicine, like acupuncturists, 
massage therapists and herbalists, have 
not been trained in scientific rules of 
evidence nor in the design of con- 
trolled trials. At the same time, our 
leading medical researchers have not 
focused their attention and talent on 
alternative medicine. As a result, sound 
research methodologies have not been 
applied to produce definitive, unbiased 
clinical trials. In this era of cost con- 
tainment, further obstacles exist 
because cost-effectiveness data regard- 
ing individual alternative therapies are 
practically nonexistent. 

In the absence of such information, 
medical providers cannot make sound 
clinical recommendations regarding 
the use or avoidance of alternative 



Sound research 
methodologies have 
not been applied 
to produce definitive^ 
unbiased clinical 
trials. 



medicine; third-party payers are 
unable to create well informed reim- 
bursement policies; and consumers of 
alternative therapy must contend with 
an endless array of unsubstantiated 
claims. 

Our center at the Beth Israel 
Hospital aims to change that status 
quo dramatically. We are planning our 



of this and every case the stu- 
dents also have a chance to 
role play. Eisenbeii; acts the 
role of the patient and students 
imagine giving advice about 
the use or avoidance of alter- 
native therapies for those with 
cancer. 

"There will always be alterna- 
tive therapies," points out 
EisenbeiK, "and this trains the 
doctor of tomorrow to put them 
in authentic perspective. How 
does a physician have an 
intelligent conversation with 
patients of this era about ther- 
apies for which there is insuffi- 
cient information regarding 
efficacy and safety? And from 
the patient's point of view, 
isn't it advantageous to identify 
a physician who is comfortable 
talking about this subject?" 

Student response to this 
course has been overwhelm- 
ingly positive, earning it 
"extremely high ratings, rarely 



achieved by any HMS course," 
says Miriam Wetzel, the cur- 
riculum coordinator in the 
Office of Educational Support 
who analyzes the student eval- 
uations for Eisenberg's course. 
An unusual 100 percent of stu- 
dents said they would recom- 
mend that their classmates 
take the course. 

"From an educator's point of 
view this course is especially 
valuable because of its empha- 
sis on the development of the 
students' critical thinking 
skills," adds Wetzel. "It is a 
course with a sound scientific 
basis and great practical 
value." 

Eisenbeii; has compressed the 
content of this course into 
three days for a CME course he 
has directed the past two 
years. The emphasis in the 
CME course is on the implica- 
tions of alternative medicine 
for clinical practice. In addition 



to reviewing and demonstrating 
the various therapies, strate- 
gies are discussed on how to 
responsibly advise patients 
who use or want to use them. 
Issues of reimbursement, cre- 
dentialing and licensure, and 
malpractice liability are also 
addressed. 

"Physicians need someone to 
translate these issues in an 
atmosphere that provides an 
intellectually safe place to have 
an honest discussion," says 
Eisenberg. 

in fact, "there is a huge inter- 
est in this area on the part of 
physicians who want to know 
more or offer more options in 
their practices," according to 
Nancy Bennett, PhD, director 
of educational development 
and evaluation for the 
Department of Continuing 
Education, in addition to 
Eisenberg's course, Herbert 
Benson '61 teaches courses on 



behavioral medicine and on 
spirituality and healing; and 
other CME courses, for exam- 
ple in orthopedics, feature 
lectures on chiropractic 
techniques. 

"My interest is how to enable 
physicians to responsibly 
advise patients regarding the 
use or avoidance of alternative 
medical therapies," says 
Eisenbei^. "This is not radical; 
it's being the patient's advo- 
cate and serving their best 
interest." 

Ellen Barlow 



Summer 1996 



23 



studies meticulously, engaging 
open-minded yet thoughtful senior 
colleagues from the affiliated institu- 
tions of Hansard to help us design 
studies that meet the accepted rules of 
evidence. We will develop research in 
managed care settings to improve our 
abilit}^ to track success or failure of 
treatments as well as costs and patient 
satisfaction. 

When and if we uncover therapies 
that work, we'll try to figure out 
whether they work because of the 
herb, the vitamin, the acupuncture 
needle, or the belief in the herb, the 
vitamin or the acupuncture needle. If, 
in some instances, it is the belief or 
expectation that predictably changes 
physiology and the course of disease, 
we must invite our basic science col- 
leagues to help unravel the mechanism 
whereby this occurs. Clinical studies 
may help identify selected individuals 
in whom this mind-body interaction is 
most strong. 

Constructive critics argue that 
much of the effectiveness of alternative 
therapy is based on the placebo 
response. There has been minimal 
research in this area since the seminal 
work of Beecher in the 1950s. Our 
center will dedicate some of its 
resources to quantifying the variability 
among placebo response rates. We 
seek to answer the question: What are 
the differences in placebo response 
rates over time and what are the fac- 
tors that will help us understand that 
variability? Our first such experiment 
is a meta-analysis of relevant clinical 
trials involving patients who are being 
treated for hypertension, one group 
with a standard antihj^ertensive, the 
second group with a placebo. 

Another priority is to develop a 
range of prospective trials to assess the 
safety, efficacy, cost-effectiveness and 
mechanism of action of alternative 
therapies. Currently under develop- 
ment at the center is a randomized 
clinical trial of a managed care popula- 
tion with low back pain. This study 
will compare patients who receive 
standard care for their symptoms with 



those who receive "expanded benefits," 
e.g., chiropractic, acupuncture, or 
massage therapies. Our goal is to find 
out if patients will have improved clin- 
ical outcomes, higher satisfaction and 
lower costs if treated with a combina- 
tion of conventional and alternative 
therapies. We also hope to learn about 
patient preferences and compliance. 
This is an exciting venture not only for 
the scientific data that it will yield, but 
because it represents an unprecedented 
and unique collaboration among a 
managed care organization, an NIH 
supported research center, and repre- 
sentative associations from the areas of 
chiropractic, acupuncture and massage 
therapy. Other projects tinder devel- 
opment at the center include: 

• A five-year follow-up to the 
national survey published in the New 
England Journal of Medicine in 1993. 

• An NIH protocol to assess the safety 
and efficacy of chelation (edta) ther- 
apy in the treatment of patients with 
coronary artery and peripheral vascu- 
lar disease. It is estimated that 500,000 
patients a year use this therapy at a 
cost of $3,000 per person, without 
established clinical studies to deter- 
mine safety or efficacy. 

• A randomized, double-blind trial to 
assess the safety, efficacy and cost- 
effectiveness of homeopathy in the 
treatment of chronic otitis media. 

Although we will focus on research, 
we will also address the current needs 
of our patients. We intend to develop 
reliable information about alternative 
medicine through the Beth Israel 
Hospital Patient and Family Learning 
Center in the new clinical center. Also 
under consideration is an experimental 
unit at Beth Israel Hospital, where 
patients who have exhausted conven- 
tional care can be referred by their pri- 
mary doctor or subspecialist for entry 
into a randomized controlled trial 
comparing conventional care to a 
combination of conventional care and 



As practitioners we 
need to know our 
morale ethical and 
legal responsibilities 
when patients tell us 
they are using an 
alternative therapy. 



alternative therapies. Patients with 
chronic low back pain are likely to be 
the first population to be studied. 

In addition, we are collaborating 
with legal scholars to anticipate the 
malpractice, liability and licensing 
issues that will affect us all. As practi- 
tioners we need to know our moral, 
ethical and legal responsibilities when 
patients tell us they are using an alter- 
native therapy. Who is responsible 
when the patient who has exhausted 
conventional care requests a referral to 
an alternative provider and the out- 
come of that referral is detrimental? In 
this regard, the field of alternative 
medicine is at a crossroads similar to 
that of assisted reproductive technolo- 
gies 20 years ago: an increasing market 
and availability, viath the legal and eth- 
ical implications not yet determined. 

Perhaps as we begin to answer these 
legal and ethical questions, we will 
begin to feel more comfortable as med- 
ical doctors about advising our patients 
about alternative therapies. Given the 
survey data that showed that at least 
one in four of our patients are using 
alternative therapies and not telling us, 
in whose interest is it not to ask? 

There is a Chinese proverb: "Zhen 
jin bu pa huo lian," real gold does not 
fear even the hottest fire." It will be 
our focus on clinical and scientific 
evaluation that will distinguish this 
center. In the process, Beth Israel 



24 



Harvard Medical Alumni Bulletin 



Hospital and Harvard Medical School 
will establish a new standard of excel- 
lence in this emerging field. 

Why should Harvard Medical 
School be a leader in this? My answer 
is a quote from David Grimes, who in 
writing about medical technology 
(jama June i6, 1993), exemplifies a 
central premise of our new center: 
"Doing everything for everyone is 
neither tenable nor desirable. What is 
done should be inspired by compas- 
sion and guided by science, and 
not merely reflect what the market 
will bear." 

Medical therapies should be 
inspired by compassion and guided by 
science. This, I believe, is the mission 
of our center and ultimately what 
medicine is about. I suspect that in the 
coming years we will see an explosion 
of knowledge about alternative thera- 
pies gained by the application of both 
compassion and science to the care 
of others. ^ 

David M. Eisenberg '80 is assistant 
professor of medicine at Harvard Medical 
School and director of the Beth Israel 
Center for Alternative Medicine Research. 
He serves on the Advisory Council to the 
NIH Office of Alternative Medicine. 



Summer 1996 



25 



Call for a New 
Medicine 



by James S. Gordon 



E\TERY DAY, THOUSANDS OF AMERICANS 
are turning in desperation from con- 
ventional medicine to other forms of 
healtii care. Those who call me say 
they have heard "something" about 
alternative medicine or a holistic 
approach, acupuncture or hypnosis, 
nutrition, herbs, chiropractic, home- 
opathy, or group support; a story 
about someone who seemed hopeless 
but who is now well; some encourag- 
ing remark that rings an obscure bell. 
They are, they tell me, sick and often 
sick and tired too, of the way they've 
been treated as well as the treatments 
they've been receiving. 

When they arrive, they say they 
believe that alternative therapies are 
somehow more hopeful, as well as dif- 
ferent from conventional ones. They 
are eager for a hoHstic approach, one 
that recognizes that they are whole 
people with feelings as well as fevers, 
with likes and dislikes in addition to 
lab values. And they, along with 60 
milhon other Americans who each 
year use unconventional therapies, are 
ready to commit their minds, bodies 
and money to what they hope will be a 
more effective and respectful, less 
toxic, less expensive, and altogether 
better way to receive care and care 
for themselves. 

Though alternative medicine 
includes such distinctiy modem tech- 
niques as intravenous chelation ther- 
apy, and though these techniques may 
be used in a way that is as narrowly 
instrumental as any conventional 



medical procedure, the presiding 
spirit of this approach is grounded in 
traditional healing systems and is inte- 
grative and embracing. All these sys- 
tems — from classical Chinese medicine 
to Indian Ayurveda to South American 
indigenous heahng practices to North 
American "natural medicine" — are 
based on an understanding that mod- 
ern biomedicine has largely forgotten. 
7\11 tell us that we are part of a larger 
world, and indeed, a small version, a 
microcosm of it. We are made of the 
same stuff as the earth, water and air 
around us. We are as connected to 
the cycles of our planet's seasons, the 
quadrants of the compass, and the 
hours of each day as we are to the ebb 
and flow of the blood and chemicals in 
our bodies. 

These systems declare that we are 
spiritual beings, emanations of some- 
thing beyond us, as well as bodies and 
minds. They remind us that we are 
connected to one another, to the earth, 
and to that beyond in ways that are 
more powerful and deeper than any of 
us may know. Disease, they explain, 
represents an imbalance within our- 
selves and between ourselves and the 
natural, social and spiritual world. Our 
health and our healing depend not 
only on careful diagnosis and expert 
intervention, but on a restoration of 
that balance. 

Most of the people who choose 
and use alternative therapies and a 
holistic approach are suffering from 
the chronic, often debilitating. 



sometimes life-threatening conditions 
that have been called "diseases of civi- 
lization." Sixty million Americans have 
high blood pressure and are particu- 
larly vulnerable to heart disease and 
stroke. Forty million of us have arthri- 
tis, and some ten million are afflicted 
with asthma. This year, more than one 
million people will be diagnosed with 
cancer and, during our lifetimes, as 
many as forty percent of us will 
develop one form or another of it. 
Thirty million Americans will have a 
clinical depression at some point in 
their hves. Twenty-three million of us 
suffer from migraine headaches, and 
up to 80 percent of our population 
will at one time or another have a 
back problem. 

For some of these people, conven- 
tional medicine has provided litde 
more than symptomatic relief. Others 
have found the side effects of treat- 
ment to be almost as distressing as the 
illness itself. And even those whose 
treatment has seemed successful — for 
example, patients with certain kinds of 
cancers — are searching for some way 
to build up their bodies, minds and 
spirits, as well as to oppose the assault 
of their disease. Still others — an 
increasing number it seems — have 
turned to alternative or hohstic practi- 
tioners in search of a comprehensive 
imderstanding or a patient, respectful 
attention that they have found missing 
in conventional care. 

A few who look for help from alter- 
native medicine, and indeed some who 



26 



Harvard Medical Alumni Bulletin 




practice it, utterly reject the principles 
and practices of biomedicine. To 
them, this world view seems hopelessly 
reductionistic, its techniques — surgery, 
chemotherapy and radiation — bar- 
baric, and its practitioners suspect. 
The vast majority of patients and prac- 
titioners, however, are desperately 
searching for a synthesis, some way to 
use both conventional and alternative 
approaches. They want to be able to 
rely on the sureness and potency of an 
established medical system that has 
served them well over time and 
promises to succor them should they 
fall desperately ill. At the same time, 
they want to avail themselves of the 
therapies of other practitioners and of 
an approach that complements and 
enriches their ongoing treatment. 

The "new medicine" that increas- 
ing numbers of physicians and patients 
are creating together is, we hope, this 
kind of synthesis. It includes biomedi- 
cine's belief in analysis, and makes use 





of its powerful genetic and biochemi- 
cal observations and imderstanding, 
and its chemotherapeutic and surgical 
treatments, but it is not limited to or 
defined by them. It puts all of these 
into a context in which they are 
aspects of a broader view of medicine 
and healing and, indeed, being human. 
At the heart of the new medicine is 
an approach to physical and psycho- 
logical functioning that is celebratory 
as well as scientific. The new medicine 
fosters an optimistic and hopeful atti- 
tude toward the experience of illness, 
an understanding that illness can be a 
great teacher — about what our stresses 
are and where we may need to direct 
our lives — as well as a misfortune. The 



new medicine is based on a therapeutic 
relationship that is more egalitarian 
than authoritarian, a true healing part- 
nership. And it creates a new synthesis 
of ancient and modern, conventional 
and unconventional techniques, the 
best of modern science and the most 
enduring aspects of perennial medical 
wisdom. 

In the practice of the new medicine 
the drugs and surgery that are cur- 



SuMMER 1996 



27 



rentl\- central to biomedicine are 
peripheral — highly prized, but seldom 
and carefulh- used. Approaches that 
have been regarded as peripheral — 
self-awareness, relaxation, meditation, 
nutrition, exercise — are its vital center. 
Self-care is understood to be the true 
priman,' care. Health promotion is a 
way of life. 

Increasing numbers of us are offer- 
ing this new medicine — of synthesis, 
self-care, partnership, and transforma- 
tion — to patients whose desperation or 
discernment has driven them to search 
for it. The challenge now is to find out 
which aspects work best, when to use 
them, and how to combine them most 
intelligently. We need also to insure 
that this new synthesis is available to 
all patients and integral to medical 
education. 

In my recent book. Manifesto for a 
New Medicine, I've discussed the ele- 
ments of this approach and show how 
they may be woven together in the 
rich tapestry of clinical practice. Here 
I want to step back and take a look at 
some of the changes this practice 
implies for our service delivery sys- 
tems, research and education. 

Service 

The new medicine ultimately depends 
not on any particular technique — 
conventional or alternative — but on 
the attitude of those who practice it. 
It suggests that we must reanimate 
the concept of service that brought 
most of us to medicine, that we must 
recall that service to others is both the 
medium for all our ministrations and 
a great honor and privilege. 

Service begins with the way we 
approach our patients. Most often this 
is through a process of question and 
answer, taking a "medical history." 
We all learned in medical school to 
proceed slowly and respectfully, to ask 
about our patient's psychological and 
developmental history, to find out 
about his or her family, work and 
social lives. In many contemporary 
practices, however, this respectful, 
comprehensive understanding has 



been reduced to a hurried frontal 
assault on the biochemical and 
physiological facts. 

Even though many people suffer 
greatly from frustration and dissatis- 
faction on their jobs, their work life is 
reduced in most medical encounters to 
a line on a form about "occupation." 
Concern with the family, which so 
profoundly shapes our emotional and 
mental lives, dwindles to a few ques- 
tions, angling for genetic causation, 
about parents' and siblings' fatal and 
most significant illnesses. 

The exclusive focus is too often on 
the "chief complaint" and the "present 
illness." Physicians are there to get the 
essential information so that they can 
order the tests and procedures neces- 
sary to make a definitive diagnosis, for- 
mulate a treatment plan, and prescribe 
the appropriate drugs and the neces- 
sary surgery. The whole range of peo- 
ples' lives and histories, save for their 
previous surgeries, major diseases, and 
allergies to medication, is cropped 
from the picture. Too many aspects of 
the current medical system — fi-om 
the narrowness of the biomedical per- 
spective, to the time pressures on 
interns and residents, to the partially 
self-generated and endlessly justified 
economic constraints — encourage this 
way of seeing and doing things. It has 
to change. 

In addition to restoring our con- 
cern with careful and complete history 
taking, we have to establish another 
kind of relationship with our patients. 
In place of the compliance that so 
many physicians seek, we need 
respectful collaboration. Patient com- 
pliance with doctors' prescribed regi- 
mens is notoriously poor. Patients 
who are asked say they often feel 
manipulated or that the prescribed 
medications are a way to avoid dealing 
with real causes and real issues. 

Collaboration and full participation 
in all aspects of their care is another 
matter. I've observed that patients who 
never have complied — for example ex- 
addicts and teenagers with chronic 
illness — will, when they are ready to. 



enthusiastically embrace programs 
they have helped design, ones that 
respect their perspective and enable 
them to help themselves. 

There are, of course, times for 
authoritative medical intervention, of 
both the conventional and the uncon- 
ventional kind. A patient with an 
overwhelming infection is in need of 
an expert to select and administer the 
most appropriate antibiotic, just as 
someone with an acute musculoskeletal 
problem may benefit from osteopathic 
or chiropractic manipulation and 
acupuncture. However, for the kinds of 
chronic problems with which the vast 
majority of people must daily deal, 
teaching, not treatment, is primary. 
And teaching, the respectful sharing of 
perspectives and knowledge, depends 
on this therapeutic partnership. 

In the new medicine, the majority 
of our therapeutic work is based firmly 
on approaches and techniques that 
patients can learn and do themselves. 
These include exercises to promote 
self-awareness; relaxation, meditation, 
guided imagery, biofeedback and self- 
hypnosis; changes in diet and the use 
of herbal therapies; physical exercise, 
the meditative movements of yoga and 
tai chi, breathing techniques, and pos- 
tural reeducation. These have become 
the heart of my and many of my col- 
leagues' medical practice, as well as the 
central elements of a lifelong process 
of health education and promotion. 

When actual treatment — the 
doing of something to one person by 
another — is necessary, the preferred 
means is to restore the body to its 
natural state of balance rather than to 
interfere with normal as well as abnor- 
mal biological processes, producing 
side effects, and reducing symptoms, 
without addressing the causes of 
illness. The new medicine suggests 
that only if these approaches are inad- 
equate should we use the powerful 
drugs and surgical procedures that 
have in recent years become the staple 
of everyday care. 

In the future, for example, we 
might insist on manipulation, 



Harvard Medical Alumni Bulletin 



acupuncture, massage, and baths for an 
injured back prior to even considering 
long-term use of anti-inflammatories 
or back surgery. Homeopathy, dietary 
changes and herbal remedies — all of 
which are supported by some good sci- 
entific evidence and centuries, if not 
millennia, of clinical experience — 
could be the initial treatment for such 
common ailments as sinus and middle 
ear infections, diarrhea, hay fever, and 
other allergies. For asthma, we might 
no longer routinely prescribe inhalers, 
bronchodilators and steroids — sub- 
stances that combat the inflammation 
and constriction of the bronchi but 
create dependence and do not signifi- 
cantly alter the course of the illness or 
address its causes. These have their 
place, but as last resorts, not as pri- 
mary treatments. Instead, we might 
preferentially, and wherever possible, 
begin therapy with acupuncture and 
herbs, as well as family discussions, 
self-awareness, and relaxation tech- 



niques, breathing exercises, dietary and 
environmental change, and yoga. 

This new medicine of self-care and 
nontoxic intervention is already being 
practiced by several thousand physi- 
cians. Some, like me, work individu- 
ally, using a number of modalities and, 
when appropriate, referring to conven- 
tional medical specialists and noncon- 
ventional practitioners. Increasingly, 
physicians are working in groups with 
nurses, acupuncturists, biofeedback 
technicians, nutritionists, massage 
therapists, chiropractors and other 
practitioners. Some of these groups 
function as physicians' private prac- 
tices; others are holistic health centers, 
more or less close confederations of 
professionals who work collaboratively 
and refer patients to one another. Still 
others — in rapidly increasing num- 
bers — are components of health main- 
tenance organizations like Kaiser's. 

This kind of perspective and 
practice is also emerging in hospitals. 



Some anesthesiologists, imderstanding 
that the briefest of interventions can 
reduce postoperative medications and 
time in the recovery room, are teach- 
ing relaxation and breathing tech- 
niques to their pre-op patients. Long 
skeptical oncologists in my city and 
around the country are now referring 
their patients to therapists who use 
relaxation therapies, guided imagery 
and group support. Orthopedists and 
physiatrists are introducing manipula- 
tive therapies, acupuncture and mas- 
sage into their wards and clinics. 

Nurses in cardiac care and intensive 
care units are providing therapeutic 
touch — a hands-on healing technique 
that has been demonstrated to 
decrease anxiety and discomfort — 
along with high-tech medical interven- 
tions. Acupuncture is already a 
primary treatment for addiction; and 
biofeedback has become a staple of 
pain control. In multi-disciplinary 
units of behavioral, mind-body. 



No Turning 
Back 



It was an agonizing lower-back 
injury 23 years ago that led Jim 
Gordon '66 to remedies that 
were antithetical to everything 
he had been taught in medical 
school. The answers to his 
immediate problem became the 
questions for further explo- 
ration, a process that has led 
to his synthesis of traditional 
and alternative medicine. 

At the time he injured his back, 
he was a research psychiatrist 
at the National Institute of 
Mental Health, establishing a 
model program for working 
with runaway and homeless 
young people. Bed rest didn't 
help his back. Repeated visits 
to the orthopedists "were 
becoming progressively less 
cordial." A myelogram, a 



prelude to back surgery, was 
recommended. 

"By this time I was desperate," 
writes Gordon in Manifesto for 
a New Medicine: Your Guide to 
Healing Partnersliips and the 
Wise Use of Alternative 
Therapies. "Each day in the 
office was an ordeal, if I took 
muscle relaxants, I would grow 
sleepy during the meetings 
where we thrashed out the 
details of our program. If I 
didn't, I was in agony as I 
drove around the city to work 
with the kids and their coun- 
selors. My attention span was 
short. I couldn't write the 
papers I had promised journal 
editors. Ordinarily fairly even 
tempered, I was now poised on 
the edge of anger, ready to 
shout at anyone who crossed 
me. In constant pain, still stiff, 
and bent over, I felt three 
times my age." 



Someone suisested that he 
see an osteopath; though he 
could figure out that it had 
something to do with bones, at 
that time he had never heard 
of osteopathy, a medical ther- 
apy in which the back is 
"manipulated." He felt better 
after each treatment but the 
pain and paresthesias returned 
minutes to hours later. Close to 
despair, he decided to call a 
Chinese-trained, Indian 
acupuncturist and naturopath 
named Shyam Singha, whom 
he had heard about a year ear- 
lier from an English friend who 
had been helped by him. 

Singha told him to stop the 
medicine, take hot baths with 
Epsom salts followed by cold 
showers, and to eat nothing 
except three pineapples a day 
for a week. An HMS graduate 
and a NIMH researcher, 
Gordon of course wanted to 
know why. Singha's explana- 



tion: pineapple has malic acid 
and malic acid affects the lung 
and colon, which in Chinese 
medicine are the mother of the 
kidney and bladder, which are 
connected to the back. 

"He was right — it made no 
sense to me. But I didn't want 
a myelogram, and I knew I 
didn't want surgery. Nothing 
else had worked, and none of 
my doctors even had anything 
else to offer. He had helped 
Richard. And something about 
Dr. Singha, an authority I did 
not understand, moved me. I 
decided to do what he said." 

After three days, he called 
Singha. His mouth was full of 
sores, he had a 103-degree 
fever, his back hurt as badly 
and the paresthesias were as 
strong as the day he injured it. 
To prevent the sores, he was 
told to put honey on the 
pineapple. The rest, Singha 



Summer 1996 



29 



complementan' and alternative medi- 
cine, tliese modalities and others are 
being- combined to address such stub- 
born problems as chronic pain, hyper- 
tension and insomnia. I would hope 
that in die very near hiture these kinds 
of approaches will be considered part 
of a truly comprehensive medical 
approach, as vital to good hospital care 
as drugs and surgery. 

It seems entirely possible that if we 
enlarge our perspective and practice of 
medicine, we might expect not only 
better outcomes, but financial savings 
as well. Indeed, recent studies on the 
alternative or mind-body approach to 
specific disease conditions have 
demonstrated significant cost-benefits. 
Work with people with chronic pain at 
the Deaconess Hospital's Mind/Body 
Medical Institute showed that ten 
classroom sessions — presenting infor- 
mation on the mind-body connection, 
relaxation training, yoga and problem- 
solving skills — not only decreased the 



depression and anxiety that ordinarily 
accompany this condition, but 
saved $ioo per person per year in 
physician visits and other medical 
costs. Stanford's Arthritis Self-Help 
Program recorded even larger savings 
for its patients: as much as $648 per 
person per year over a four-year 
period for people with rheumatoid 
arthritis. Since as many as 70 million 
Americans have chronic pain and two 
million have rheumatoid arthritis, the 
potential savings in these two condi- 
tions alone are enormous. 

The economic benefits of bringing 
this new medicine into high-cost 
hospital settings are even greater. One 
simple intervention undertaken at the 
University of Miami, the use of regular 
therapeutic massage for low birth- 
weight babies, not only produced more 
normal growth and development and 
strengthened the maternal-infant 
bond, but saved a great deal of money. 
These babies were able to leave the 



hospital on an average of six days 
earlier than those who were not mas- 
saged, at an average saving of some 
$3,000 per child. 

Research 

This kind of care is already immensely 
attractive to Americans. We know 
from David Eisenberg's New England 
Journal study that in 1990 one-third of 
the American people made 425 million 
visits to alternative care practitioners 
and spent some $13.7 billion on 
unconventional medical care, $10.5 
billion of which they paid out of their 
own pockets. And there is little doubt 
that since then, all these figures have 
increased significantly. But public 
interest and acceptance is not enough 
to certiiy effectiveness or insure 
progress. Enduring change in medi- 
cine depends on reliable information, 
on research as well as hope and need. 
And research requires a commitment 
of scientific expertise and money. 



said, was a good sign: in 
Chinese medicine a chronic 
disease must become acute 
before it can be healed. By the 
weelt's end, Gordon's back was 
80 to 90 percent better, he 
was 12 pounds lighter and "far 
clearer in my mind." Per 
Singha's instructions, he went 
back to the osteopath and this 
time the adjustment held. 

His recovery excited him, 
though "the means had been 
even more outlandish and 
improbable than the man 
who'd made it happen." He 
writes: "But something had 
come alive in me during this 
therapy, some direct full con- 
nection to my own biological 
processes, some inkling that 
there were, perhaps, secrets in 
the natural world that were not 
revealed by our texts of bio- 
chemistry and physiology." 



He did a little self-experimenta- 
tion to find ways to ease his 
bad alleiiEies without antihista- 
mines. He drank herbal teas, 
ate garlic and onions, and felt 
better. That excited him 
enough to do some serious 
reading on herbalism, folk 
remedies and Chinese medi- 
cine. He learned about a folk 
remedy for allergies: chew a 
cubic inch of locally produced 
honeycomb three times a 
day for three months. He did 
and by spring, "discovered 
that my allei^ies had ail but 
disappeared." 

He met Singha about a year 
after he recovered from his 
back problem. This time he 
was a very willing student. 
"Listening to Dr. Singha speak 
about the ancient laws of 
Chinese and Indian healing, I 
could feel his words, like some 
living force, working and surg- 
ing in me. Later, when he 



treated me with acupuncture, 
I felt a power I had never 
imagined." 

Gordon was eager to learn 
more. He thought these thera- 
pies might help the kids with 
whom he was working. But 
Singha told him to foi^et about 
those kids for now. He said 
that he could teach him tech- 
niques and treatments that 
work, but that first the person 
who uses them has to change. 
He prescribed six months of 
daily meditation with "chaotic 
breathing," a practice in which 
one breathes as fast and as 
deeply as possible through the 
nose while pumping the arms 
like a bellows for 40 minutes. 

Six months later, he says, "I 
felt more at home in my body, 
looser in my injury-jammed 
knees, lighter on my feet, more 
responsive to the taste and tex- 
ture of foods, a bit more sure 



and loving in the way I touched 
others." He began to explore 
the therapeutic use of foods 
and herbs and the points and 
meridians of acupuncture. 
Sometimes he intuitively felt 
what foods and emotions made 
his allei^ies worse on one day 
than on another, and counter 
to rational understanding, to 
"know" where to rub for relief 
of some ache, or what herb 
to use. 

A sense began to rise in him 
that maybe every person's ill- 
ness is different from everyone 
else's, and in fact different in 
the same person from one hour 
to the next; that all of us can 
explore and understand both 
our own biological and psycho- 
logical nature as well as our 
connection with Nature. He 
began to realize: "We are 
whole as well as unique, and 
each aspect of our lives — the 
emotional, mental and spiritual 



30 



Harvard Medical Alumni Bulletin 



With this in mind, Congress 
estabhshed the Office of Alternative 
Medicine (OAM) at the National 
Institutes of Health (nih). Though the 
initial budget was, as its first director 
noted, "homeopathic" — $2 million out 
of a total of $10 billion allocated to 
NIH — OAM's presence has been cat- 
alytic. Overnight, doing research on 
alternative medicine became a worthy 
subject of scientific scrutiny and a 
route to academic advancement. 
Though the office sometimes seems 
buffeted — constrained by the inherent 
conservatism of a huge scientific 
establishment and agitated by the 
impatience of patients desperate for 
cures, and researchers and clinicians 
eager for a hearing — it has found a 
place as a member of the NIH family 
and a higher level of funding. This 
year's OAM budget is $7.4 million. 

Always enormously visible — there 
were times when the numbers of calls 
and public attention were overwhelm- 
as well as the physical — is rich 
and complex and deeply con- 
nected to the others." 

He began to appreciate that all 
the dimensions of life are cru- 
cial to understanding and 
treating an individual's illness. 
From then on his life and prac- 
tice of medicine were irrevoca- 
bly changed. 

Ellen Bartow 



A central purpose 
is to explore the 
relevance and use of 
other methodologies 
in addition to 
the randomized 
controlled trial. 



ing to OAM staff and astonishing to 
NIH — the office is in a unique position 
to make available the reliable informa- 
tion that already exists on alternative 
therapies and to enlarge the scope and 
guide the direction of research. There 
are many hundreds of excellent, 
already-published studies on a variety 
of different alternative therapies — for 
example, on meditation, relaxation, 
hypnosis, guided imagery, homeopa- 
thy, chiropractic, acupuncture and 
herbal therapies. I've presented a num- 
ber of them in Manifesto for a New 
Medicine and more were noted in the 
1995 report to the OAM, Alternative 
Medicine: Expanding Medical Horizons. 
The report, which hundreds of clini- 
cians and researchers prepared over 
two years, provides an impressive 
amount of authoritative information 
about the effectiveness of these and 
other practices and possible directions 
for future research. It's a good start 
and needs to be far better known. 

Meanwhile, the OAM is assembling 
a comprehensive database of articles 
on alternative approaches. These are 
being gathered in one place, and are 
to be made easily accessible to re- 
searchers, clinicians and consumers. In 
addition, there is a growing recogni- 
tion of the importance of making sure 
the information in the report and the 
database actually exercises some effect 
on medical practice and research. 



Drug companies expend hundreds of 
millions of dollars to present the 
research findings on their products, 
over and over, to every physician and 
medical student. We should, in the 
public interest, spend a portion of the 
NIH's money to do the same for all the 
promising, nonpatentable, nonphar- 
macological therapies. 

In addition to making available 
existing data, the office is collaborating 
with NIH's various institutes and 
funding ten centers — at Harvard, 
Columbia and Stanford, among other 
medical institutions — to promote and 
guide high-quality research. It is also, 
through a series of methodology 
conferences, taking a fresh look at the 
research enterprise itself. One of 
the central purposes of these confer- 
ences is to explore the relevance 
and use of other methodologies in 
addition to the randomized controlled 
trial (RCT). 

Because the RCT has proved enor- 
mously useful and because its results 
are so statistically powerful, it has 
become the "gold standard" of clinical 
research, the one by which other kinds 
of studies tend to be judged. This has 
had real consequences, since many 
new approaches have been ignored or 
dismissed by the medical establish- 
ment because their efficacy has not 
been — or can't be — demonstrated by 
RCTs. It is also important because the 
structure of the RCT helps to deter- 
mine what can be most definitively 
judged to be effective. RCTs work best 
for simple interventions with easily 
definable disease states. 

Here the complexity of the 
individual and the variability among 
individuals — our uniquenesses — are 
ignored in favor of statistically aver- 
aged outcomes: intervention x lowers 
blood pressure in 60 percent of 
patients with hypertension. The RCTs 
shape research in another way. They 
are the central element of clinical tri- 
als, the complex series of studies that 
must be undertaken before any new 
drug can be approved for use by the 
Food and Drug Administration, a 



Summer 1996 



31 



process that may cost hundreds of 
niilhons of dollars. 

Though RCTs and clinical trials are 
enormously useful, they are only 
one aspect of research. Because the 
linancial incentives are not there to 
launch these kinds of investigations of 
substances and devices that cannot be 
patented — including herbs, vitamins, 
homeopathic remedies, dietary regi- 
mens, and other food supplements — 
there will inevitably be far fewer and 
far less elaborate investigations of 
them. The same is also true of 
acupuncture, chiropractic, and all of 
the mind-body therapies like hypnosis 
and imagery. This imbalance has noth- 
ing to do with which approaches are 
more promising, only with which ones 
might be most profitable. 

It's not a matter of discarding the 
randomized controlled trial but of 
respecting and using other methodolo- 
gies as well. Outcome studies, exami- 
nations of clinical practice in its 
natural setting are, for example, far 
less expensive and far simpler to per- 
form than RCTs. They are often 
perfectly adequate to answer questions 
about what works: Dean Ornish's 
Lifestyle Heart Trial, in which 
patients' progress was monitored, was 
such a study. 

The office is also exploring meth- 
ods that respect the integrity of the 
systems or techniques that are under 
study. So for example, if we are look- 
ing at the effectiveness of a Chinese 
medical approach, we might need to 
assess it according to its ability to 
affect conditions that are defined and 
described according to Chinese, not 
Western, diagnostic categories. 

The office is also becoming inter- 
ested in addressing other kinds of 
research questions, ones that may help 
identify factors that are most con- 
ducive to healing. What are the unique 
factors that enable one person to 
recover — to experience a "spontaneous 
remission" — from a metastatic cancer 
to which all others succumb? If, as 
research shows, placebos produce 
effective results 30 to 40 or sometimes 



70 percent of the time, what can one 
do to maximize the positive belief on 
which the placebo response is based — 
and to minimize the negative expecta- 
tions that may undermine it? If 
physician/patient relationships have an 
effect on outcome in illness, what are 
the factors that go into producing this 
effect, and how do we make sure 
physicians — and patients — make the 
best use of them? 

Finally, we need to widen the con- 
cerns of our research, from its too 
exclusive focus on magic bullets — 
which one set of experts will design 
and manufacture and another will 
fire — to the human being whose illness 
is being targeted. What we have so far 
learned about our ability to use hypno- 
sis and biofeedback, visual imagery and 
prayer, exercise and postural reeduca- 
tion, attitudinal change and group 
support, to affect our physical and 
emotional functioning and well-being, 
are, I feel, just hints of our true capac- 
ity. Research — at the OAM and else- 
where — should not only help us see 
what we can do to and for others, but 
help us realize all that we are capable 
of doing for ourselves and give us the 
confidence to do it. 

Medical Education 
The new medicine demands a new 
kind of medical education, as well as a 
broader approach to research. This 
education will be at once more per- 
sonal, experiential and thoughtful. It's 
not that what students are learning is 
destructive or even incorrect, or that 
progressive deans aren't aware of and 
moving to address some of its prob- 
lems, but rather that medical educa- 
tion is limited in its perspective and is 
less than what it can and should be. 

Changes in medical education can 
begin with changes in its financing and 
in school admission policies. We 
should publicly fund the education of 
all students — not just those who are 
willing to enter the armed forces — or 
the few who can and choose to join the 
National Health Service Corps. In 
return we should require that all 



The new kind of 
medical education 
will be at once more 
personal^ experiential 
and thoughtful. 



graduates devote three years to the 
chronically underserved in the irmer 
cities and rural areas. This would 
establish the value we, as a society, 
place on service to all, and discourage 
those who see medicine as a vehicle 
primarily for technical mastery or 
monetary gain. 

It would encourage students who 
are interested in primary care and 
eliminate barriers to medical school 
for those, largely poor, who cannot 
imagine incurring debts of as much as 
$150,000 to $200,000. It would also 
eliminate one of the obvious and 
unpleasant rationalizations that doc- 
tors advance to justify the inflated 
incomes that many of us achieve. 
Admissions policies should be changed 
to reflect this perspective, with com- 
mitment to service, open-mindedness, 
hfe experience, and intellectual curios- 
ity weighed equally with high scores in 
science classes and on the Medical 
College Admissions Test. 

There also need to be major 
changes in medical education itself. 
There is a lot of hard work, but it is 
often neither intellectually challenging 
nor stimulating to the imagination. 
We need to teach our students to 
examine biomedicine, the experimen- 
tal methods on which it is based, 
and the social system in which it is 
practiced from an historical and a 
cross-cultural perspective. They 
ought to know that our medicine is 
one among many; that healing systems 
that have been ignored or dismissed 
as "primitive" have a long and 



32 



Harvard Medical Alumni Bulletin 



successful history, can be scientifically 
investigated and validated, and are 
more and more widely used by 
their patients. 

We must also remind medical stu- 
dents from the first day that each of us 
is unique and that all of us are far more 
than the sum of our diseased organs — 
that we are whole people living in rich 
and complex environments. This can 
happen only if we ground medical 
education in specific human perspec- 
tives and experiences as well as facts 
and diagrams. A renewed emphasis on 
the primacy of the physician/patient 
relationship is essential. 

Students need to visit with patients 
in their homes and at the places where 
they work, to interview whole families, 
not just the individual patient. They 
need to thoughtfully observe the 
effects of hospitalization and, indeed, 
all medical treatment on patients' 
physical and emotional states, to 
appreciate the negative as well as the 
positive effects of medical technology 
(for example, the rise of antibiotic- 
resistant bacteria and the unnecessary 
prolongation of fife of the demented 
elderly). 

In most aspects of the medical 
curriculum, we tend to divide knowl- 
edge into convenient and somewhat 
arbitrary categories, disciplines and 
specialties — biochemistry and bacteri- 
ology, as well as internal medicine and 
preventive medicine, otolaryngology 
and pulmonology. We need to balance 
this sharp focus with broader, more 
integrated perspectives. When stu- 
dents learn gross anatomy, for exam- 
ple, they shouldn't learn only where 
each muscle originates and inserts but 
how they work together. 

The physiology of stress, which is 
usually only touched on, is one com- 
prehensive and coherent way of look- 
ing at the effects of our environment, 
our thoughts, and our feelings on our 
biological being. It also represents a 
wonderful opportunity for experiential 
teaching. Instead of monitoring a 
dog's physiology, students can observe 
how stress raises their own blood 



pressure, alters their own blood chem- 
istry and changes their own moods. 

From the first day, we need to bal- 
ance the necessity for analytic study 
and expertise with introspection and 
personal experience, the acquisition of 
knowledge with the necessity of wis- 
dom. Already, several schools make 
sure their students know the names 
and hfe stories of the cadavers they 
dissect and hold a ceremony of appre- 
ciation for those whose bodies serve 
our learning. A few ask their students 
to experience the anxiety and dehu- 
manization that often accompanies 
medical care: a visit, as a patient, to an 
overwhelmed ER; a simulated pelvic 
examination with their legs in stirrups 
for males; a brief ward admission, 
complete with unclosable hospital 
gown. And in some schools, like 
Harvard, students are already working 
and learning together in small groups. 

These are important beginnings. 
However, our education needs to 
evolve beyond isolated glimpses of 
patients' reality and problem-based 
learning about patients. All students 
need to learn to understand and help 
themselves. If they pay attention to the 
influence of their own family, class, 
race and environment, students will be 
far more likely to be sensitive to the 
power of these dimensions of their 
patients' lives. If they are willing to 
explore their own stresses and attitudes 
and discover their own ability to deal 
with them through awareness, relax- 
ation, meditation, exercise and diet, 
they will find it natural, once they are 
on wards and in clinics, to teach this 
approach and these therapeutic 
modalities to their patients. 

If students share their thoughts and 
feelings with one another, they will 
realize the power of this process to 
ease anxiety, break down interpersonal 
barriers, and create bonds of trust. 
Later, on wards and in clinics, they 
will feel more comfortable inviting 
their patients to do the same with 
them. If they begin to explore their 
own need for meaning and purpose — if 
they address the role of the spiritual in 



their lives — they will understand the 
importance of this dimension to those 
who are passing through terrifying and 
life-threatening crises. 

Medical students who expand their 
intellectual horizons to include other 
systems of healing are likely to be far 
less dogmatic and more modest in 
their practice. And students who learn 
in a deeply personal and mutually 
respectful way will be less vulnerable 
to the isolation and self-protectiveness 
of unhealthy competition. As they 
continue to explore their own capacity 
for self-awareness, self-care and 
mutual help, to open their minds to 
new approaches, they will be far more 
likely to value and encourage these 
possibilities in their patients. If they 
are treated, and learn to regard one 
another, with love and respect, they 
may well come to treat their patients 
the same way. ^ 

James S. Gordon ''66 is author of the 
recently published Manifesto for a New 
Medicine: Your Guide to Healing 
Partnerships and the Wise Use of 
Alternative Therapies (Addison Wesley, 
1996). He is director of the Center for 
Mind-Body Medicine; clinical professor in 
the depai-tme77ts ofPsychiatfy and Family 
Medicine at Georgetown Medical School; 
and chair of the Progi'am Advisory 
Council of the Natiorial Institute of 
Health ''s Office of Alternative Medicine. 
The views in this article are his own and 
do not represent the official position of the 
National Institutes of Health. 



Summer 1996 



33 



Mesmerism and 
Kindred Delusions 



by Gerald Weissmann 




The Mesmeric approach to mental conditions. 

From: Shyrock, R.H. The Development of Modern Medicine, 1947 



34 



EUrvard Medical Alumni Bulletin 



Sickness, [Mesmer] maintained, resulted 
from an obstacle to flow of the fluid 
through the body, which was analogous to 
a magnet. Individuals could control and 
reinforce the fluid's action by ''''mesmeriz- 
ing'' or massaging the body^s '^poles" and 
thereby overcoming the obstacle, inducing 
a ''crisis, " often m thefonn of coTiviilsions 
and restoring health and hai'mony of man 
with nature. 

Robert Darnton, 
Mesmerism and the End of the 
Enlightenment in France, 1968. 

Most women today are borderline hysteri- 
cal. We are loudly hysterical or quietly 
hysterical. Our despair is acted out exter- 
nally, or it cuts through our bodies in the 
form of physical illness. . .Her psychoimmu- 
nologist had told her before we met — and I 
agree — that her body has merely caught 
up with her mind. 

Marianne Williamson, 

A Woman's Worth, 1993 

No one can study the now familiar 
history of clairvoyance profitably who has 
not learned something of the vagaries of 
hysteria. 

O.W. Holmes, 

A Mortal Antipathy, 1878 

No CITY IN fflSTORY HAS PROFESSED 
more ardendy the belief that human 
reason is the sister of medical progress 
than nineteenth-century Boston, 
which Oliver Wendell Holmes called 
"the hub" and Van Wyck Brooks 
called the city of Oliver Wendell 
Holmes. Boston was the hub not only 
of the American Renaissance, but also 
of a broad social movement in the 
Western democracies that came to be 
called meliorism. Meliorism differs 
from simple altruism by virtue of its 
belief in progress through reason 
rather than sentiment. An altruist 
feeds the beggar; a meliorist feeds the 
beggar and vaccinates his children. 
Believing that meliorism is the spirit 
that unites the age of abolition with 
the age of DNA, I'd bet that Holmes 
would have been vastly amused by the 
notion of "alternative" medicine sit- 




Oliver Wendell Holmes 

ting cheek by jowl with molecular 
biology at his medical school! 

Those who presided over the 
flowering of New England — Holmes, 
Lowell, Longfellow, Emerson — ^would 
have been pleased by the flowering of 
DNA, an event foreseen by Emerson: 

/ do not know that I should feel threatened 
or insulted if a chemist should take his 
protoplasm or mix his hydrogen, oxygen, 
and carbon, and make an animalcule 
incontestably swimming and jumping 
before my eyes. I should only feel that it 
indicated that the day had anived when 
the hinnan race might be trusted with a 
new degree of power, and its immense 
responsibility; for these steps [are] only a 
hint of an advanced ft-ontier supported by 
an advancing race behind it. 

Ralph Waldo Emerson, 

Joiniials, 1 871 

His friend and fellow meliorist. 
Holmes, would have scoffed at the 
"Homeopathy and Kindred 
Delusions" (the title of one of 
Holmes's essays) of our day — the 
clairvoyants, remote healers, stress- 
reducers, aytirvedics, herbalists, crystal 
gazers and psychoimmunologists. 
Holmes had no great hopes of winning 
the debate against unreason, invoking 
what he called the hydrostatic paradox 
of controversy: "If you had a bent 
tube, one arm of which was the size of 



a pipe-stem and the other big enough 
to hold the ocean, water would stand 
at the same height in one as in the 
other. Thus discussion equalizes fools 
and wise men in the same way, and the 
fools know it" (Autoa'at at the Breakfast 
Table, 1858). But he might have taken 
that pipe-stem by its neck, were he 
told that Jon Kabat-Zinn, the son of 
one of America's most distinguished 
immunologists, Elvin Kabat, would 
profess Mesmer in Massachusetts 
today: 

[Kabat-Zinn: ] Even though the words 
?nedicine and meditation sound alike, we 
don 't want to scare people away. So we call 
it ''stress reduction. " They will leant to 
"scan " their bodies, moving consciously 
through the painful areas until they can 
"relax into their discomfort. " They will 
learn yoga, arching into a ball, raising 
their pelvises, stretching their arms over 
their head, lifting their heads and feet 
while lying on their stornachs. At first, 
groans and gnints fill the room... 

Moyers: What exactly is happening 
during the body scan? 

Kabat-Zinn: In the body scan, you lie on 
the floor, and without moving begin by 
directing the focus of your attention to the 
toes of your left foot, then, gradually, up 
through your leg and over to the other 
toes, and the other leg, and eventually 
through the whole body. Afteiivards you 
experience profound well-being. You 're in 
the present mojuent. 
Bill Moyers, 
"Healing and the Mind," 1993 

When James Russell Lowell was 
offered the editorship of a new literary 
magazine in 1853, he had made it "a 
condition precedent" that his friend 
Oliver Wendell Holmes be the first 
contributor engaged. Holmes had at 
the time a reputation chiefly as the 
author of "Old Ironsides," as a lyceum 
lecturer, and as Boston's most brilliant 
conversationahst. But he accepted 
Lowell's challenge of steady work and 
published his feuilletons in every issue 



Summer 1996 



35 




TRANSFUSION OF NERVO-VII AL VOWER 





MESMKRIZING WATRR. 



INTKO- VISION. 



of the new journal. He also gave the 
pubHcation its name. The Atlantic 
Monthly is Holmes's godchild. 

We are still in debt to his knack for 
names. Holmes not only christened 
Boston "the hub," but suggested the 
name "anesthesia" to Morton; in his 
novel Elsie Venner he introduced 
"Brahmin" as the label for Boston's 
finest class. In addition, he imported 
the study of medical microscopy from 
France to the United States, demon- 
strated the cause of childbed fever and 
invented a parlor stereopticon. He 
was, incidentally, a dean of the 
Harvard Medical School; like the 
incumbent he was a feisty gamecock 
of a man dedicated to medical educa- 
tion and reform. He was also an 
unabashed sanitary crusader, proud to 
be a member of the skeptical medical 
community of Boston, which today — 
as in 1869 when Holmes addressed 
it — should hold "every point of human 
belief, every institution in human 
hands, and every word written in a 
human dialect, open to free discussion, 
today, tomorrow, and to the end 
of time." 

His book of essays, The Autocrat at 
the Breakfast Table, made Holmes a 
household word overnight. Those 
humorous pieces, unstructured prod- 
ucts of a magpie mind, were tran- 
scripts of the doctor's thoughts 
"dipped from the running stream of 
consciousness" — a phrase made 
famous by his student, William James. 



In his 12 volumes of verse and prose, 
Holmes raised the flags of wit and rea- 
son against homeopaths, Mesmerists, 
and the politically pious. He also knew 
that medicine was practiced in a social 
context: 

The truth is, that medicine, professedly 
founded on observation, is as sensitive to 
outside infliiences, political, religious, 
philosophical, imaginative, as is the 
barometer to the changes of atmospheric 
density. Theoretically it ought to go on its 
own straightfoiiDard inductive path, with- 
out regard to changes of government or to 
fluctuations of public opinion. But [there 
is] a closer relation between the Medical 
Sciences and the conditions of Society and 
the general thought of the time, than 
would at first be suspected. 

In 1 87 1 Holmes took on the quacks 
before the graduating class of my 
medical school, then called Bellevue 
Hospital Medical College. He began 
by explaining the difference between 
the junior and senior members of our 
profession: the young doctor knows 
the rules, the older doctor knows the 
exceptions. He went on to warn the 
young graduates against the nostrums 
and "specifics" that passed for therapy 
in their century, but his chief targets 
were homeopathy and other foolish 
practices: 

Some of you will probably be more or 
less troubled by that parody of medieval 



theology which finds its dogma in the 
doctrine of homeopathy, its miracle of 
transubstantiation in the mystery of its 
dilutions, its church in the people who have 
mistaken their centuiy, and its priests in 
those who have mistaken their calling. You 
can do little with persons who are disposed 
to accept these curious medical supersti- 
tions. There are those whose minds are 
satisfied with the million-fold dilution of a 
scientific proof . No wonder they believe in 
the efficacy of a similar attenuation of 
herbs or potions. You have no fiilaiim you 
can rest upon to lift an etror out of such 
minds as these, often highly endowed with 
knowledge and talent, sometimes with 
genius, but commonly richer in the imagi- 
native than the observing and reasoning 
faculties. 

But he reserved his greatest con- 
tempt for that catch-all diagnosis of 
the nineteenth century, spinal irrita- 
tion. "Some shrewd old doctors," 
Holmes told the Bellevue students, 
"have a few phrases always on hand for 
patients who will insist on knowing the 
pathology of their complaints. I have 
known the term 'spinal irritation' to 
serve well on such occasions." 

It had already served well the 
brothers Henry and William James 
who acquired the disorder to sit out, as 
it were, the American Civil War. 
Their plucky sister Alice spent a life- 
time in bed on account of her spinal 
affliction, that "dorsal trouble in the 
blood" which William believed to run 



36 



Harvard Medical Alumni Bulletin 



in the family. The disorder was based 
on Marshall Hall's earlier description 
of the reflex arc in decapitated newts 
(1837), a reduction of higher mental 
functions to local electrical circuits. 
The notion that our spines harbor the 
secret of health and disease remains at 
the root, literally, of such curious 
American practices as osteopathy, chi- 
ropractic and Christian Science. It also 
owes a debt to the "polar" principles 
of Mesmer. 

Mary Baker Glover Patterson Eddy 
suffered a small epiphany when she 
hurt her back in 1866. Her injury was 
an "obscure hurt" of the kind that 
struck Henry James when he heard of 
Fort Sumter. She was literally struck 
by the notion that, since "matter and 
death are mortal illusions," one could 
overcome disease by exercise of Mind. 
There is, in fact, a large area of agree- 
ment between this notion and those 
expressed by Henry James the elder 
in his relentiess tract. Shadow and 
Substance. 

What a Bostonian affliction! Poor 
Mary Baker Eddy was troubled all her 
life by "spinal inflammation and its 
train of suffering — gastric and bilious" 
to the point where her second husband 
had to carry her downstairs for her 
wedding ceremony, and back to her 
invalid bed directiy thereafter. Sure 
enough, with the help of Healing and 
the Mind, she was soon able to climb 
all 182 steps of Portland's city hall 
tower. Eddy and her followers were 
persuaded that Christian Science and 
its healers constituted the main line of 
defense against "malicious animal 
magnetism," which was the main cause 
of illness and death. This not unper- 
suasive system of alternative medicine 
has continued to outiast its ontogeny 
in spinal irritation and its phylogeny in 
Mesmer's animal magnetism. 

Mesmer's theory and practice have 
proved nearly as durable as Christian 
Science and both doctrines lean heav- 
ily on the Swedenborgian notion that 
matter is a subset of Mind. As we've 
learned from Robert Darnton, there 
was a disturbing connection between 



the rise of Mesmeric belief and the end 
of the Enlightenment in both Europe 
and America. On both sides of the 
water, hard science and sharp thought 
provoked a backlash of soft science and 
dull thought. The result was a brew of 
Mesmeric fluid and Swedenborgian 
Mind as the language of real science 
was appropriated by the mock. 

Both Franz (or Friedrich) Anton 
Mesmer (1734-1815), who began as a 
Viermese physician, and Emanuel 
Swedenborg (1688-1772), who began 
as a Swedish metallurgist, slipped eas- 
ily into the language of eighteenth- 
century physics; their tomes are filled 
with tmiversal fluids and fields, forces 
of repulsion and attraction, terrestrial 
and animal magnetism. George Bush, 
no discernible relation of our recent 
leader, but a very discernible colleague 
of the elder Henry James — who was 
himself a pillar of Boston's Sweden- 
borgian community — published in 
1 847 a book entitied Mesmer and 
Swede7iborg. He spelled out for 
Americans the connection between 
the Barnum of animal magnetism and 
the Bailey of cosmologic love. 

For Bush, as for James, the rela- 
tionship between flesh and spirit was 
elementary, so to speak, it was written 
in the stars. And the stars, then as now, 
permitted one to deal with the dark 
side of the soul, with the lonely self, 
with existential angst and vastation. 
"His work gives one the feeling of a 
sky full of stars," as Lowell said of 
Thoreau, "astrology as yet, and not 
astronomy." 

Alas, there are today many more 
astrologers than astronomers in the 
United States. Americans still can't 
tell whether it's the real turtle soup or 
only the mock. Our proliferation of 
crystal healers, visualizers and 
herbalists is unmatched since the 
era of Mesmer. 

Mesmer, of course, was only the 
most fashionable and successful practi- 
tioner among that squad of Svengalis 
that serviced the pre-revolutionary 
salons of Paris. They argued that med- 
ical practice based on anatomy, botany 



and chemistry, the medicine of the 
Enlightenment, was too reductionist 
because it ignored the spiritual energy 
that united man with nature. Disease, 
they believed, resulted from various 
obstacles to the flow of a magnetic 
fluid or energetic force in the body. 
Darnton explains: 

Sitting around the tubs in circles, the 
patierits communicated the fluid to one 
another by means of a rope looped about 
them all by linking thumbs and index fin- 
gers in order tofi)r7n a mesmeric "chain, " 
something like an electric circuit. . .Soft 
music, played on wind instruments, a 
pianoforte, or the glass ^arvionica " that 
Mesmer helped to introduce in France sent 
reinforced waves of fluid deep into [the 
patienfs] soul. Every so often fellow 
patients collapsed, wiithing on the floor, 
and were caiiied by Antoine, the mes- 
merist-valet, ijito the crisis room; and if 
his spine still failed to tingle, his hands to 
treinble, his hypochondria to quiver, 
Mesmer himself would approach, dressed 
in lilac taffeta robe, and drill fluid into the 
patient from his hands, his imperial eye, 
and his mesmerized wand. 

This report does not differ from an 
account Elizabeth Blackwell gave us of 
her visit to a Mesmeric session in the 
1 840s, nor, for that matter, of those 
held a generation later. We might say 
that constancy of this degree is what 
separates a cult or religion from 
Western science, which changes so 
rapidly that it often forgets its place 
on the page. 

In the eighteenth century hard 
science struck back at Mesmer. Ben 
Franklin, one of Holmes's heroes, took 
part in the effort. The monarchy of 
the ancien regime had heard enough 
of Mesmer and his disciples and 
appointed a commission to determine 
whether Mesmerism "worked" in 
practice. The group consisted of four 
prominent doctors from the faculty of 
medicine, including Guillotin (of the 
blade), and five members of the 
Academy of Sciences, including Bailly 
(of Jupiter), Lavoisier (of oxygen), and 



Summer 1996 



37 



Benjamin Franklin (of the spark). 
Holmes ranked Franklin with Morton: 

ff V'l'p tried refonii — and chlorofonti — 
tind both hnve turned our brain; 
JJl.H'ii France called up the photograph, we 
roused the foe to pain; 
Just so those earlier sages shared the chap- 
let of renown, 

Hers sent a bladder to the clouds, ours 
brought their lightning down. 

The commissioners spent weeks lis- 
tening to Mesmeric theory and observ- 
ing how its patients fell into their fits 
and trances. They underwent continu- 
ous mesmerizing themselves, with no 
effect, and then tested the operation of 
the fluid outside the excitable atmos- 
phere of the Mesmeric clinic. They 
found false a report that being 
mesmerized through a door caused a 



woman patient to have a crisis. In 
Franklin's garden at Passy another 
"sensitive" patient was led up to each 
of five trees, one of which had been 
mesmerized; he fainted at the foot of 
the wrong one. Four normal cups of 
water were held before a mesmerized 
patient at Lavoisier's house; the fourth 
cup produced convulsions, yet she 
calmly swallowed the mesmerized con- 
tents of a fifth cup, which she believed 
to be plain water. The commissioners 
concluded, as Holmes did almost a 
century later, that the effects of mes- 
merizing could be attributed to the 
overheated imaginations of the 
mesmerists. 

William James, the finest writer 
ever to have come out of the Harvard 
Medical School, was also taken in by 
clairvoyance. James's fascination with 
the occult led him to seances held by 



Mrs. WiUiam J. Piper, a Boston 
medium. He wrote to his sister Alice 
in England asking for a lock of her 
hair that he might use to conduct help 
from the spirit world. Sure enough, 
the hair was sent and advice was 
obtained. William James was con- 
vinced that he had tested the "conduc- 
tive" power of material objects and 
confirmed the Swedenborgian corre- 
spondence of Mind and matter. But, 
shortly thereafter, Alice confessed that 
the hair she had sent was not her own, 
but that of her nurse, dead four years 
before. "I thought it a better test of 
whether the medium is simply a mind 
reader or not..." Alice James had a 
less sanguine view of the spirit world 
than her brother, calling Piper and 
her ilk "the curious spongy minds that 
sop it all up and lose all sense of taste 
and humor!" 



Lecture on homeopathy 




38 



Harvard Medical Alumni Bulletin 



Unfazed by the episode, William 
James became a president of the 
Society for Psychical Research. In The 
Will To Believe (1891), he used all his 
rhetorical power to defend the activi- 
ties of his society by pointing out the 
endurance of the clairvoyant tradition 
over the ages, "which lay broadcast 
over the surface of history. No matter 
where you open its pages, you find 
things recorded under the name of 
divinations, inspirations, demonical 
possessions, apparitions, trances, 
ecstasies, miraculous healings and pro- 
ductions of disease, and occult powers 
possessed by peculiar individuals." 

He believed at the end of his cen- 
tury what the New Age healers believe 
at the end of our own: that the "thun- 
derbolt has fallen and that the orthodox 
belief in reductionist science has not 
only had its presumptions weakened, 
but the truth itself. . .decisively over- 
thrown." Well, not really. Reductionist 
science in James's own field of medicine 
has had a decent run since its "over- 
throw" by Mrs. Piper. The sanitary rev- 
olution of Holmes's day was followed 
by the bacteriologic revolution, and this 
in turn was succeeded by the biological 
revolution, which I have called the 
flowering of DNA. 

The results are easy to judge from 
the only meaningful bottom line, life 
or death. In 1920 — at the end of the 
bacteriologic revolution and before the 
discovery of antibiotics — the average 
life expectancy in the U.S. was 53.6 
years for males and 54.6 for females. 
By 1990 the life expectancy of males 
had increased to 71.8 and females to 
78.8. There is no evidence that 
between 1920 and 1990 intervention 
from the spirit world has increased, or 
that the "truth itself has been deci- 
sively overthrown. The various tribal, 
religious, and spiritual methods of 
healing had 5,000 years of head-start 
before scientific medicine took over; 
under the care of shamans or priests 
human life expectancy did not reach 
40 until 1840! 

Reductionist, scientific medicine 
may still be helpless in the face of 



metastatic cancer, AIDS — or even 
chronic backache. And the rude 
machines of medical progress may 
have defeated, in part, the pastoral role 
of the family doctor. But that is no 
reason to settle for magic potions, 
meditation or "stress reduction." 
There is no homeopathic, ayurvedic 
or New Age practice that can prevent 
pandemics of plague, pin a hip, replace 
a retina, or prolong the life of a tot 
with the tetralogy of Fallot. Psycho- 
immunologists ignore the Swan-Ganz 
catheter. 

When Kurds, Somalis or Bosnians 
suffer from the revival of traditional 
tribalism, they do not call for shamans 
or homeopaths, but the plasma and 
antibiotics of Medecins sans frontieres. 
The cholera and dysentery epidemics 
of Rwanda were quelled by salt, potas- 
sium and antimicrobials from stores 
kept by the medical services of the 
American and French military. When 
the Ebola virus threatens the world 
from Zaire, aid comes not from 
herbalists or chiropractors, but from 
the CDC in Atlanta. While the clinics 
for which I am responsible routinely 
treat Asian or African women flown to 
the United States for their medical 
care, I know no patient who has 
booked passage to less spiritually chal- 
lenged sites such as Tibet or the 
Kalahari desert for the treatment of 
lupus nephritis. 

We are told frequently nowadays 
that the expensive, autocratic, medical 
science of our day has substituted its 
own elite values for those that would 
better serve one or another of our sub- 
cultures. It seems to me that I have 
heard that song before. From the dock 
at Nuremburg, Karl Gebhard, MD told 
a disbelieving Major John J. Monigan 
of Newark and the Adjutant General 
Corps of the United States that Hitler 
and his lieutenants "were all attracted 
to 'natural medicine'... they had a 
childish enthusiasm. All sorts of popu- 
lar drugs that were not approved by 
the medical profession allegedly 
because we did not understand them 
or were too conceited or were 



financially interested in the suppres- 
sion of them, were used experimentally 
in concentration camps. . .What the 
National Socialists wanted to do was 
to introduce a popular medicine." 

Those fashionable folk who gave 
you Mesmer also gave you the original 
1 8th of Brumaire: a takeover by a 
nationalist despot in love with the 
military. Barras, displaced on the 
1 8th by Napoleon asked: "when this 
moment arrives, and the secretly 
conducted workings of opinion have 
reached their terms, where are the 
human resources which will be able 
to oppose it?" 

Holmes had his moment when 
he opposed the Mesmeric medical 
practices of his day in his essay on 
"Homeopathy and Kindred 
Delusions": 

As one humble member of [the medical] 
profession, which for more than two thou- 
sand years has devoted itself to the pursuit 
of the best earthly interests of mankind, 
always assailed and insulted from without 
by such as are ignorant of its infinite com- 
plexities and labors, always striving in 
unequal contest with [disease] not merely 
for itself but for the race and the fiiture, I 
have lifted my voice against this lifeless 
delusion, rolling its shapeless bulk into the 
path of a noble science it is too weak to 
strike, or to injure. ^ 

Gerald Weissmann is professor of 
medicine and director of the Division of 
Rheumatology at New York University. He 
has published five books of essays and cul- 
tural histoiy; the latest book is Democracy 
and DNA (Hill and Wang, 1996). This 
essay is based in part on the second 
Katherine Swan Ginsburg lecture given at 
Brigham and Women 'j Hospital in June 
/pp5 and is dedicated to her family. 



Summer 1996 



39 




'"^^■'^glKKim-ti^lllm^flm^iitmli^^m 






1^ 





^ ie 




Wired for God 



by Herbert Benson 





Excerpted from Chapter p o/Timeless 
Healing by Herbert Bensofi, MD with 
Marg Stark. Copyright © ipg6 by 
Herbert Benson, MD. Reprinted by 
permission ofScribner, an imprint of 
Simon if Schuster, Inc. 



iigT' 



Much of the time, the scientific quest I've described in this 
book was driven by the question "Is that all there is?" 
Scientific medicine always seemed to me, in the patients I 
encountered and in the research I compiled, to be cordon- 
ing off parts of the human experience it wanted to affect. In 
the process, we neglected those aspects that patients, if 
asked, would probably identify as the essence or meaning of 
their lives. This was particularly frustrating because my 
research consistendy demonstrated that "the essence of Hfe" 
was also a wellspring of health. 

Acting on Instinct 

But as much as my journey was pushed onward by medical 
research results, it was also driven by instincts. So in this 
chapter, I will tell you what I instinctively came to believe 
was timeless and immutable about human physiology and 
human existence. As informed as my search has been by the 
traditional measures of science, and as much evidence as I 
have that my conclusions are scientifically sound, it is at this 
point in my search that I've reached the end of what I 
believe science can ultimately prove. 

Very early on in my quest for answers, nearly thirty years 
ago, I had one of the most profound thoughts I've ever had. 
Like most of my better ideas, it came to me when I was 
shaving. Mind and body research aside, I've found that 
nothing rouses the intellect like a sharp blade making tracks 
across one's face. So it was that I stood in front of a mirror 
one morning, razor to chin and deep in thought. I was 
mulling over the facts as I knew them at that point: 
Scientists had proven the existence of a brain-controlled 
state of relaxation in animals, the same relaxation response 
that I would later identify in humans. 

I'd seen that Transcendental Meditation practitioners 
could relax the physiologic mechanisms usually aroused by 
stress. And although at the time I didn't know the precise 



formula for calling this relaxation forward, the steps did 
not appear to mysterious or difficult to learn. I hypothesized 
that I would be able to find examples of the use of a repeti- 
tive focus in both secular and religious settings, and specu- 
lated that the relaxation response was being elicited in 
everything from Lamaze breathing exercises to religious 
rituals around the world. 

Razor in hand, I continued thinking, harking back to 
my college paper and the commonalties of religious 
experience that William James had so beautifully docu- 
mented. It seemed that as long as people had lived, they 
had worshipped. 

And then it struck me. "This is prayer!" I exclaimed to 
my half-shaven reflection. Perhaps this tendency of humans 
to worship and believe was rooted in our physiology, writ- 
ten into our genes, and encoded in our very makeup. 
Perhaps it is what distinguishes us from other life forms, 
this innate desire to believe and to practice our befiefs. 
Perhaps instinctively, human beings had always known that 
worshipping a higher power was good for them. And 
indeed, if they were calling forth the relaxation response, 
medical science could prove it was good for them! I specu- 
lated that perhaps humans are, in a profoimd physical way, 
"wired for God." 

Wired for God? 

The notion that humans might be wired for God seemed 
to me to be so beyond the realm of traditional scientific 
study that, as exhilarated as I was about the possibility of its 
being true, I was also immediately very fearful. Who was I 
to try to quantify and document faith in God? I could not 
have found any subject matter more controversial. There 
was nothing more sacred to people than religous faith. And 
there was nothing so "unscientific" as faith. Moreover, I felt 
woefully unprepared to launch a search for the physical 



Herbert Benson '61 began his 
professional career very much 
within scientific tradition, first 
as a cardiology fellow and then 
as a research fellow with 
Clifford Barger '43a in his 
physiology laboratory in the 
mid-sixties. Mind and body 
were considered distinctly sep- 
arate entities then and stress 
was seen as a mental phenom- 
enon, not a cause of physical 
illness. But intrigued by an 
observation now known as 
"white coat" hypertension — 
abnormally high blood pressure 
taken during a physician's 



exam, now suspected to be due 
to stress — Benson began a 
series of experiments. 

He trained squirrel monkeys to 
control their own blood pres- 
sure through feedback tech- 
niques and found that those 
who were rewarded for 
increases in blood pressure 
eventually developed hyperten- 
sion and kidney changes. That 
work attracted the attention of 
young people practicing tran- 
scendental meditation, who 
finally persuaded Benson to 
study them. He discovered that 



meditation led to decreases in 
heart rate, oxygen consump- 
tion, rate of breathing and 
blood pressure. 

Harvard faculty at the time 
looked somewhat askance at 
this work, and Benson almost 
left Harvard because senior 
administrators told him he 
could not accept a private 
grant to pursue such research. 
The administrators consulted 
then-Dean Robert H. Ebert, 
who decided, "If Harvard can't 
take an occasional chance on 
something new, who can? Take 
the money." 



Benson then conducted a 
series of experiments that 
showed that the "relaxation 
response" — as he called the 
result of repeating a sound, a 
word or a phrase, keeping out 
intruding thoughts — could be 
used to reduce hypertension 
and other medical conditions. 

He has just published a new 
book that brings his thinking 
to a new provocative level. 
— Editors 



42 



Harvard Medical Alumni Bulletin 



manifestations of faith. No class, no textbook, and no grand 
rovtnds I could remember had ever attempted to ascertain 
the physical properties or merits of belief in God. 

And yet, while nothing about my medical training 
prepared me for this, my interactions with patients, their 
families, and with people in general led me to believe that 
my hypothesis was sound. The idea that humans are wired 
for God, that we are custom-made to engage in and exercise 
beliefs, and that spiritual beliefs are the most powerful of 
that sort, felt like a truth that had always existed inside me 
and inside of humankind to which I had suddenly gained 
conscious access. Like synesthesia, which we talked about 
earlier in the book, it was as if a physical process had risen 
to the surface, so that for the first time I was attuned to a 
primal human motive and a timeless source of physiologic 
strength and health. 

Why do I suspect that belief in God is a primal motive or 
a survival instinct? Let me summarize the findings of this 
book that led up to my conclusion. We've examined how 
influential faith can be when cultivated by an individual, by 
someone caring for an individual, or by the relationship 
between the two. We've demonstrated that beliefs have 
physical repercussions, both positive as in remembered 
wellness and negative as in the nocebo effect. And we've 
explored how our culture, ethnicity, and daily experiences 
shape our beliefs and thus our physiology. 

Then we delved deep into the workings of the brain, 
where we witnessed an astonishingly complex system in 
which patterns of nerve cell activation are created and 
stored, and in which life experiences mingle with genetics, 
constantly shifting the cellular pathways that determine all 
our thoughts, movements, feelings and functions. We 
learned that people come into the world with hard-wired 
instincts (among others, fear of heights, or acrophobia, and 
fear of snakes, ophidiophobia), with the fight-or-flight 
response, and with the notion of being "whole" — of having 
arms, legs and a torso. These are genetic predispositions. 
Our brains became wired with these strategies because 
they enabled the survival of our ancestors and the continua- 
tion of the species. We also unconsciously react to all the 
things that happen to us and to all our ideas with emotional 
markers, the logic and origins of which we have yet to 
imderstand. 



Because we are the only species that can ask, "What will 
happen to me after I die?," we must answer that question in 
a way that promotes our survival. 

Cicero is reported to have said, "All philosophy only 
talks about one thing — death." I have come to believe that 
in order to counter this fundamental angst, humans are also 
wired for God. Whether or not God exists, our genes guar- 
antee that we will bear faith and that our bodies will be 
soothed by believing in some antithesis to mortality and 
human frailty. So that we will not be incapacitated by the 
acknowledgment and dread of death, our brains harbor 
beliefs in a better, nobler meaning to Hfe. 

Karen Armstrong writes in A History of God, "Jews, 
Christians, and Muslims have developed remarkably similar 
ideas of God, which also resemble other contemplations of 
the Absolute. When people try to find an ultimate meaning 
and value in human life, their minds seem to go in a certain 
direction. They have not been coerced to do this; it is some- 
thing that seems natural to humanity." Behef in God is, 
indeed, natural to humanity, as natural as are our instincts 
to flee or fight. As we saw earlier in the book, these prede- 
termined instincts often result in common archetypes being 
developed, our common fears and tendencies becoming the 
legends of very different lands and peoples. Similarly, we 
develop ideas of the almighty, because it appears we are 
programmed "to go in a certain direction." 

After my shaving insight, I spent two years reviewing the 
religious and secular literature of the world for a common 
formula that would elicit the relaxation response. I found 
that in every nation, in every religion, the results were the 
same. Every culture had religious or secular practices that 
consisted of two basic steps — a repetitive focus and a passive 
attitude toward intrusive thoughts. There was transforming 
power in prayer, no matter what the words, from a Hindu 
prayer to the Catholic "Hail, Mary, full of grace," from 
Judaism to Buddhism, Christianity, and Islam. There 
were multitudes of descriptions of the peaceful state these 
religious practices elicited. Furthermore, I found many 
examples of secular approaches that brought forth the 
physiologic relaxation I'd seen in practitioners of 
Transcendental Meditation. These were scientifically 
proven techniques such as Lamaze breathing, autogenic 
training, and progressive muscle relaxation exercises. 



The Burden of Mortality 

But we haven't talked about the fact that humans are 
saddled with an intelligence that threatens our very exis- 
tence. While we are the most intelligent creatures on the 
planet, outsmarting all other animals, we are also, arguably, 
the only species that recognizes its own mortality, the 
inevitability of death. In pondering such questions and 
facing such facts, ignorance may be bliss because the recog- 
nition of death can be such a torment, so depressing and 
anxiety-producing in humans as to impair our survival. 



Life Significance 

Whether or not you believe in God per se, you attach 
purpose and significance to your life. Of course, individuals 
choose to manifest this wiring, this preset instruction, in 
very different ways. But we all derive the most intense 
strength and solace from seemingly transcendent qualities 
of life. 

Some people look to children for their inspiration 
because children are untainted and ripe with possibilities. 
For others, gardens are deeply soothing, a profusion of 



Summer 1996 



43 



color and life, constantly reborn. At their best, music and 
art can inspire generation after generation of listeners and 
admirers, as can natural wonders — mountains mingling with 
clouds, ocean tides never ceasing, and a sun that emerges 
even' morning ha^dng been swallowed by the horizon the 
night before. 

Faith in God, however, seems to be particularly influen- 
tial in healing because "God," by all definitions of which 
I am aware, is boundless and limitless. It is part of our 
nature to believe in an almighty power lest our health be 
undermined by the ultimate and dreadful fact — that we 
may succumb to illness and that all of us must die. 

I describe "God" with a capital "G" in this book but 
nevertheless hope readers will understand I am referring to 
all the deities of the Judeo-Christian, Buddhist, Muslim, 
and Hindu traditions, to gods and goddesses, as well as to all 
the spirits worshipped and beloved by humans all over the 
world and throughout history. In my scientific observations, 
I have learned that no matter what name you give the 
Infinite Absolute you worship, no matter what theology you 
ascribe to, the results of believing in God are the same. 

Furthermore, I fear that the language in this chapter and 
in others in which I've discussed the spiritual experience 
will seem strained and inadequate, no matter how carefully 
wrought. Humans have always known this frustration, try- 
ing to represent that which is mystical and divine in finite, 
limited terms. And by our very mind-sets — pigeonholing 
science and religion, mind and matter — most of us are 
uncomfortable linking God and genes, spirituality and 
nerve cells. 



Transcendent Faith 

I have found that faith quiets the mind like no other form of 
belief, short-circuting the nonproductive reasoning that so 
often consumes our thoughts. Our bodies are very good at 
healing us but all too often we hinder this process, worrying 
that a cough could be indicative of something far worse 
because we've read or heard so many worst-case scenarios in 
the media, doubting that we have the strength to overcome 
it without help because that's what a host of advertising 
agencies and pharmaceutical companies have told us. These 
worries and doubts bring on the fight-or-flight response 
with all of its stress-related symptoms and diseases and 
blunt our evolutionary honed healing capacities. Perpetual 
worries and doubts also make an impression on our nerve 
cells so that the body too frequently "remembers" illness 
and health threats in the nocebo effect phenomenon we've 
discussed. 

But because faith seems to transcend experience and base 
reality, it is supremely good at quieting distress and generat- 
ing hope and expectancy. With hope and expectancy comes 
remembered wellness — the neurosignature messages of 
healing that mobilize the body's resources and reactions. 5f 

Herbert Benso?i '6i is associate pi'ofessor of medicine at Harvard 
Medical School and president and founder of the Mind/Body 
Institute at the Deaconess Hospital. He is the author of the 
Relaxation Response and many other books about the relation- 
ship between the body and mind. 



44 



Harvard Medical Alumni Bulletin 



Rebel with a Cause 

Andrew Weil is proud of liis past as a 
rebel. As a student at Harvard Medical 
School he acted against the grain of the 
Northeast medical establishment. "We 
were a restive class," he comments, 
readily admitting that he was no small 
influence: "In the second year [at HMS] I 
led a student revolt. We petitioned Dean 
Ebert that we could teach ourselves better 
than his faculty could. Five students seri- 
ously followed through with our proposal. 
By the end of the year, the five of us who 
were self-taught passed the National 
Boards exam." 

In keeping with this spirit (and that of his 
time), Weil chose to research marijuana 
usage as his senior elective. Despite fac- 
ulty doubts about this choice, his research 
led to a series of articles in Nature, 
Science and the New England Journal of 
Medicine, among other publications. Weil 
also used some of this research in writing 
The Natural Mind (Houghton Mifflin, 1972). 

Since his years at HMS, Weil has gone 
on to use his undergraduate training in 
botany (biology) to collect information on a 
number of other plants besides marijuana, 
all in the interest of studying alternative 
methods of healing the body. Weil's posi- 
tion is that conventional, allopathic medi- 
cine has its place alongside homeopathy 
and other remedies. 

"The advantage I have over other people 
in the field [of alternative medicine] is that 
I don't have an allegiance to any one sys- 
tem. I think I'm fairly even-handed in my 
criticism of all of them. I think they all have 
strong points and weak points, and for me 
the goal is to sort that out and to take the 
best elements and ideas from all of these 
systems and put them together in new 
combinations." 

Weil is far from pessimistic about the 
enormity of this task. He is optimistic 
about both his own progress over the past 
20 years and society's acceptance of 
alternative medicine. "For a while I was in 
a fairly lonely position. But I find it interest- 
ing and gratifying to see the extent of 
change of public opinion in this area 
and the amount of credible support 
and attention." 




Weil is currently director of the Program in 
Integrative Medicine at the University of 
Arizona College of Medicine, where an old 
schoolmate of his, Joseph Alpert '69 is 
chair of the Department of Medicine. Much 
of his work at the University of Arizona 
involves the development of a two-year 
fellowship program in integrative medicine 
for physicians who have completed resi- 
dencies in family practice and internal 
medicine. In addition to the usual mix of 
teaching, clinical work and research, 
these fellows will be schooled in the 
philosophy of science, the history of medi- 
cine and mind-body interaction. Fellows 
will be required to master two different 
therapies, ranging from osteopathic 
manipulation and acupuncture to 
homeopathy. 

Weil is also the founder of the Center for 
Integrative Medicine, in Tucson, Arizona 
and the author of six books, the most 
recent being Natural Health, Natural 
Medicine (Houghton Mifflin, rev. 1995) 
and Spontaneous Healing (Alfred A. 
Knopf, 1995). 

Weil's ideas about physician training and 
temperament are as unconventional as the 
program he offers University of Arizona 
students. "The premise I work from is that 
the body can heal itself, if given the 
chance. I think that if doctors are going to 
facilitate healing, we have to start by 
selecting people who have aptitudes for 
it." Weil doesn't believe that high scores 
on standardized tests in any way indicate 
a qualification to foster healing. "I think 
that for doctors to be effective teachers 
of healthy living they have to be able to 
model health for patients, and I think that 



medical training, as it's now set up, 
actively thwarts the development of 
healthy lifestyles." 

Weil cited his days on a medical rotation 
at the Peter Bent Brigham as a perfect 
example: "If you missed a meal at the 
cafeteria, there was a little room with a 
big plastic tub of saltine crackers, a tub of 
peanut butter and jelly, and a vending 
machine with candy and soda." 

Weil lives in a secluded and plant-filled 
desert home outside Tucson, Arizona. In 
his latest book. Spontaneous Healing, he 
strongly espouses vegetarian diets and 
breathing exercises for relaxation. "I think 
the most effective way to teach is by 
modeling, and therefore the process of 
becoming a doctor should include training 
in and evaluation of the acquisition of 
healthy habits of living." Weil himself walks 
or bicycles almost every day and eats a 
vegetarian diet. 

It's the simplicity, accessibility and, one 
might even say, traditional qualities of his 
ideas that have made his books so appeal- 
ing to lay readers. Spontaneous Healing 
has been on the best seller list over six 
months in hardcover, and the paperback 
is currently on the best seller list as well. 

In describing the practice of medicine Weil 
emphasizes the open-ended aspect of this 
profession: "I think that it's important for 
physicians to be comfortable with mys- 
tery. I think that medicine is not a science, 
it's an art. It uses scientific information 
produced by scientific research, but the 
manner of interacting with patients and 
presenting treatments is an art form. We 
can never completely understand why 
people do or don't get better." 

Sarah Jane Nelson 



Summer 1996 



45 



Native Healing 




by Scott H. Nelson, 
Maiy Ann ^Neal and 
Abe Pliifmner 




A Navajo healing ritual 



The three of us sat on the ground 
on thick blankets in a Navajo hogan. It 
was 9:00 p.m. and in the low light of 
the wood fire, we watched a medicine 
man as he sang prayers and instructed 
his patient, a Navajo woman, probably 
in her mid 30s, who suffered from 
intense headaches. Dressed in her 



finest Navajo clothes and jewelry, the 
woman sat silently, her back to the 
wall, facing a five-foot sand painting of 
a corn stalk. The hogan was a one- 
room, log and adobe structure with six 
sides and a single east-facing entrance. 
It was filled with parents, grandpar- 
ents, uncles, aunts, children and 
trusted friends who came to support 
the patient and the healing process. 
The family included us because we 
were known indirectly as people who 
could be trusted and who would 



contribute positive support to the 
healing ceremony. 

The medicine man, a stocky man in 
his 60s, dressed simply in traditional 
Navajo clothing, conducted the cere- 
mony slowly and carefully, following 
the multiple steps of singing, chanting, 
praying, blessing and talking to the 
patient, using corn pollen, tobacco and 
items from his medicine bundle in 
ways that had been passed down from 
generations. Finally, the patient was 
seated on the sand painting to convey 
to her its symbolic power and healing 
properties. Then the sand painting was 
destroyed and the patient was bathed 
discreetly by her family behind a cur- 
tain. It was 5:30 AM. 



1^ 




Through the next day, the patient 
and participants rested, slept and 
tended to chores to prepare for one 
more night of singings. By the end 
of the ceremonies, the patient's 
headaches were gone, and four months 
later they had not recurred. 

For almost a year the physicians 
and other health professionals at the 
Indian Health Service (IHS) Hospital 
had treated the patient's headaches 
without success, despite complete bat- 
teries of diagnostic tests, specialty 
consultations and various attempts at 
treatment. Finally, the 
woman and her family con- 
sulted one of the several 
types of Navajo diagnosti- 
cians, a charcoal gazer, 
who determined that the 
headaches were the result of 
her having dreamed about 
speaking with a dead rela- 
tive. The diagnostician and 
the family's chosen medi- Spiritual 

cine man then discussed the 
diagnosis, and the medicine 
man determined the appro- 
priate healing ceremony. 

Traditional medicine is 
actively practiced by an 
increasing number of the 
more than 500 American 
Indian and Alaska Native 
(ai/an) tribes in the United 
States; it is increasingly 
emphasized as many tribes vigorously 
rekindle their traditional languages, 
activities and culture. Traditional heal- 
ing approaches include ceremonies, 
feasts, sweats, vision quests, talking 
circles, prayers, singing and herbal 
remedies. The form and substance of 
the healing varies according to the dif- 
ferent cultures of the tribes involved. 

While the methods of traditional 
healing are unfamiliar and enigmatic 
to many Western-trained physicians, 
they are frequently used and highly 
effective. Even more important, native 
healing practices are based on princi- 
ples that physicians are taught in med- 
ical school, albeit superficially, such 
as "treating the whole person" and 



providing treatment "in ways that the 
patient will accept and understand." 
The authors have found that under- 
standing some of these principles has 
helped us to become more effective in 
our own practices of psychiatry and 
social work with Indian patients and 
their families. 

A good way to start understanding 
any traditional healing is to learn 
about the belief and value structure of 
the individual in the context of his 
family, community and culture. For 
example, the world view of the Navajo 



Physical 




Mental 



is quite different in many ways from 
that of the dominant society. Navajos 
believe that all things are related 
rather than separate; that natural 
things should be protected and 
respected, not conquered and 
despoiled; that material wealth is for 
giving and sharing rather than acquir- 
ing. Illness is seen as the lack of bal- 
ance and harmony among the physical, 
emotional, mental and spiritual aspects 
of the self. Medical or psychiatric 
problems are not seen to occur solely 
from psychological or physical origins 
within one's knowledge or self-con- 
trol, but may have spiritual or super- 
natural causes from "witches" or 
"ghosts," or be due to an unconscious 



violation of a traditional taboo. 

The medicine wheel (see illustra- 
tion) is a useful construct for under- 
standing how many Al/AN cultures 
view health and illness. The wheel 
consists of a circle that is intersected 
by four spokes created by two inter- 
secting lines. The four points on the 
circle represent natural phenomena 
that occur in groups of four — for 
example, the directions and the sea- 
sons. In ai/an cultures, the points also 
represent the physical, mental, emo- 
tional and spiritual aspects of the self. 
The view of the Navajo 
(and many other indige- 
nous cultures) is that these 
aspects of the self must be 
in proper balance and har- 
mony for health to be 
present. Conversely, illness 
(disease) exists when they 
are out of balance. The 
purpose of the various 
imotionai methods of traditional heal- 

ing thus is to restore the 
previously existing balance 
of the self s components. 

Perhaps the unique and 
most important contribu- 
tion of the native concept 
of health is the emphasis on 
the spirit. The concept of 
spirit in native cultures 
includes one's religious 
beliefs and relationship to a 
creator. It often also includes the 
degree of harmony with and accep- 
tance of certain other cultural values: 
one's relationships with extended fam- 
ily, the protection and reverence for 
the environment (including other ani- 
mals and plants), and the emphasis on 
sharing and communality rather than 
acquisition of goods and individuaHsm. 
Many American Indian healing sys- 
tems, including the Navajo, emphasize 
what can be done to remain healthy 
and in balance. In Western medical 
practice, we are used to thinking along 
more unidimensional lines, focusing 
on the physical causes of illness. Some 
of us may also consider emotional and 
social factors affecting the acceptance 



48 



Harvard Medical Alumni Bulletin 



or course of treatment. It is more 
imusual for us to consider such factors 
as the cultural history, values and 
beliefs of patients, their views of the 
world and their spiritual needs. This is 
beginning to change; for example, the 
new fourth edition of the Diagnostic 
and Statistical Manual of Mental 
Disorders (dsm IV) of the American 
Psychiatric Association for the first 
time includes an outline for cultural 
formulation and a glossary of culture- 
bound syndromes. 

The two million AI/ans are the 
fastest growing ethnic minority in the 
United States. Over half live in urban 
areas, and about half are under age i8. 
About 1 60 different native languages 
continue to be spoken by the more 
than 500 tribes. Tribes range in size 
from over 200,000 members (Navajo 
and Oklahoma Cherokee) to small 
bands of fewer than 100. While simi- 
larities exist, tribes are very diverse 
in their language, customs and geo- 
graphic locations. 

Indian individuals and their com- 
munities differ in the degree of assimi- 
lation into the dominant society. Not 
all Indian people believe in traditional 
medicine and its benefits; some iden- 
tify largely or wholly with Western 
values, including the practice of mod- 
ern technological medicine. Many 
of these tribes have lost their own 
language and traditional practices alto- 
gether. The Navajo and Pueblo tribes 
of the Southwest, on the other hand, 
tend to be highly traditional, and have 
largely maintained their language, cer- 
emonies and discrete land boundaries. 

Other tribes are in transition, 
focusing on revitalizing their cultural 
traditions and ceremonies and reviving 
their languages, while at the same 
time responding to the pressures and 
expectations of the dominant society. 
Achieving an appropriate balance is 
challenging and often stressful in 
these transitional communities, partic- 
ularly for native youth. Yet many 
Indian people find the integration of 
Western and traditional approaches 
to be rewarding and to provide 



alternative ways of dealing with life 
issues and stresses. 

To treat Indian patients, it is 
important for a Western physician to 
understand the historical context of 
their lives. The sordid treatment of 
native peoples in the United States, 
with expropriation of lands and forced 
loss of language and culture, have 
eroded the self esteem of generations. 
In many native communities today, 
depression, alcoholism and other 
dysfunction are the persisting legacy. 
Fortunately, the revitalization of 
culture seems to be an effective anti- 
dote to these manifestations of trauma 
and grief. 

Our view at IHS is that both 
Western and traditional healing are 
valid and effective. In fact, we believe 
that not to refer an Indian patient to a 
native practitioner is irresponsible if 
the patient believes in such healing 
and has not considered it, and if com- 
petent native healers are available. 
Interestingly, issues related to quality 
of care and cost-effectiveness are now 
being raised, even with traditional 
healers. Should insurance or IHS pay 
for the work of diagnosticians, herbal- 
ists and medicine men? Traditionally, 
payment has been considered the 
responsibility of the family, but some 
patients have been reluctant to seek 
out traditional healing because of their 
inability to pay. 

Similarly, what criteria can or 
should be used to evaluate quality of 
care provided by native practitioners? 
Indian communities are increasingly 
concerned about "healers" who are not 
trained by recognized effective tradi- 
tional mentors. Accepted standards of 
care for traditional healing are now 
being documented through organized 
efforts of native providers. 

Those of us who are unaccustomed 
to considering the validity and use of 
traditional heafing can take time to 
talk with patients about their cultural 
beliefs in an accepting way, particu- 
larly as their beliefs relate to health 
and illness. We should remember that 
Western medicine is not the only 



effective way to heal some afflictions. 
Indigenous peoples often believe that 
treatment must be holistic and posi- 
tive, and behef in the method of heal- 
ing and in the healer is often the most 
important factor to successful out- 
comes. Consider suggesting to patients 
from traditional cultures that they 
pursue traditional healing, if it seems 
appropriate. 

The traditional healing of 
American Indians and Alaska Natives 
has been applied for centuries longer 
than Western medicine in its current 
form. It can be used as an effective 
alternative when Western methods fail 
or fall short. Traditional medicine 
succeeds in large part because its lan- 
guage, metaphors and symbols are 
meaningful and because patients 
believe in its methods and trust the 
healer as competent and caring. The 
cultural beliefs of indigenous peoples 
can enrich our knowledge and experi- 
ence, and can help all of us in our 
constant mission to improve the care 
of our patients. ^ 

Scott H. Nelson '66 is chief of mental 
health programs, Mary A?in O'Neal, 
ACSIV, is chief of social services and Abe 
Plummer, LICSW, is Navajo area mental 
health and social service branch chief for 
the Indian Health Service. The views 
expressed in this article do not necessarily 
represent those of the Navajo Nation or 
the hidian Health Sei-vice. 



Summer 1996 



49 



Who Did the First 
Appendectomy? 



hy S. Halcuit Moore Jr. 



From a corpus of anatom- 
ical studies by Leonardo 
da Vinci, never published 
in his lifetime. Johnson 
Reprint Co Ltd., Harcourt 
Brace Jovanovich, 1979. 



f '»X''|i' -.yi^»M o]»"'</' 






r^, 



;{'//( i^l^ vrf fps '.< '^'^'Kni 





--•"- ' ■'» ig »'i» » gi| j «iw p |i.i"H 



/ MNfior^ ♦dot n-j 



-- 'V i;'*!'!" ''«*'«''''^ •■(«•»» 



\ 



rr • 




'7j '7 *'» ♦^ •^'f '«< •>/»> if*'}?! 



5° 



Harvard Medical Alumni Bulletin 




Alfred Worcester 

My search for the answer to this 
question began in March 1933. We 
were having dinner in Vanderbih Hall 
and talking about milestones in the 
history of medicine. A fourth-year 
student, Don Gates from Gray, Maine, 
spoke out: "I know the doctor who did 
the first appendectomy." 

There was silence for a moment, 
and then I commented, "Surely the 
person who did the first appendectomy 
must have died a long time ago." Don 
was quick to reply, "Then why don't 
we drive over to Cambridge and have 
Dr. Alfred Worcester tell us about the 
operation he did in 1886?" 

Three of us made the trip to the 
Student Health Center located in 
Wadsworth House in Harvard Yard. 
We found that Worcester was 
delighted to tell us about the nine- 
year-old girl who had been sent home 
from the Massachusetts General 
Hospital so she could die. Her parents 
had learned that Worcester was rec- 
ommending surgery for patients with 
this same problem, and they had 
arranged for him to see her. He had 
explained the great risk involved, and 
after considering the matter, they had 
asked him to proceed with surgery, 
which he did on August 21, 1886. The 
3 1 -year-old Worcester was assisted by 
his senior associate, Edward Rowland 
Cutier, who had graduated from 
Harvard Medical School in 1863, 
when Alfred Worcester was eight. 



After the abscess cavity was drained, 
Worcester removed the appendix and 
the child made a satisfactory recovery. 

I asked, "Dr. Worcester, was that 
the very first appendectomy ever per- 
formed?" The other students were 
putting questions to him so rapidly 
that my question never got an answer. 
On the way back to Vanderbilt Hall I 
decided I would go to the library and 
get the complete facts, but it was years 
later before I would make a serious 
investigation. 

My curiosity was rekindled when I 
read in the Dallas Morning News on 
January 4, 1990 that on this date in 
1885 the first appendectomy was per- 
formed by William West Grant at 
Davenport, Iowa. I wrote to the local 
medical society in Davenport for more 
information. They sent me a full 
report of the operation, which was not 
truly an appendectomy, but was an 
attempt to close a fistula that had 
persisted after an appendiceal abscess 
had drained. 

This operation was not publicized 
vmtil 20 years later when a feature 
article appeared in the local Davenport 
newspaper, the Demoa-at. It was writ- 
ten by the doctor who had adminis- 
tered the anesthetic. They made it a 
cause for great celebration, showing a 
bold headline THE GREAT APPENDEC- 
TOMY, leaving the impression that it 
was the first appendectomy ever done. 
Grant never claimed that he had done 




Reginald Fitz 



the first appendectomy. He did four 
different operations on this patient 
before he finally succeeded in curing 
her problem in January of 1892. 

After this wild goose chase, I went 
to the medical library and read Ralph 
H. Major's Classic Descriptions of Disease 
and Howard A. Kelly's Appendicitis 
and Other Diseases of the Vennifonn 
Appe?tdix. I found various contradic- 
tions and some confusion as to whom 
the credit should be given. Much of 
this was clarified by the concise 
accoimt given by G. Rainey Williams 
of Oklahoma City in his presidential 
address before the Southern Surgical 
Association and published in Annals of 
Surgery in May 1983. The confusion 
largely stems from the fact that in the 
years before Reginald Fitz gave his 
historic paper in 1886, explaining what 
appendicitis is all about, much of the 
discussion dealt with such questions as 
"When is the best time to drain the 
appendiceal abscess?" 

My search of the medical literature 
soon revealed that the first recorded 
appendectomy was performed in 
London in 1735 by Claudius Amyand. 
The appendectomy was incidental to 
the repair of a large inguinal hernia 
which had distended the scrotum of an 
1 1 -year-old boy. In the middle of the 
operating field was the appendix with a 
rusty pin protruding from the tip. 
After removal of the appendix, the 
hernia repair was completed and the 
boy made a satisfactory recovery. 

A landmark case was the appendec- 
tomy done by Abraham Groves, who 
operated on a 1 2 -year-old boy on a 
kitchen table in a farmhouse near 
Fergus, Ontario in 1883. Some histori- 
ans claim that this was the first exam- 
ple of a case in which inflammation of 
the appendix was diagnosed before 
surgery, with successful removal of the 
diseased appendix before peritonitis or 
abscess had developed. 

Another noteworthy case was the 
appendectomy performed by Richard 
John Hall on May 8, 1886. According 
to two biographers, Howard A. Kelly 
and George A. Higgins, this was the 
first successful operation for acute 



Summer 1996 



51 



appendicitis and peritonitis performed 
in die United States. Others say this is 
not correct, because the appendix was 
removed as an incidental part of the 
correction of a strangulated hernia in a 
patient -with peritonitis. The appendix 
was coiled on itself in such a way that 
it appeared to be a normal testicle, but 
on closer inspection, Hall found a per- 
foration at the tip of the inflamed 
appendix and removed it. 

Hall and his coworker William S. 
Halstead deserve special recognition as 
pioneers in surgery. They worked 
together at the Roosevelt Hospital in 
New York, where they did experi- 
ments on the use of cocaine as a local 
anesthetic and both became addicted. 
Richard Hall moved to Santa Barbara, 
California as part of his rehabilitation 
program, and succeeded in overcom- 
ing his addiction. It is ironic that he 
later developed appendicitis and called 
for his friend Beverly McMonagle to 
travel from San Francisco to operate 
on him. There was no surgeon in the 
Santa Barbara area capable of doing 
this type of surgery. McMonagle did 
operate on him, but too late, and Hall 
died. The autopsy showed that he had 
died from a ruptured appendix and 
peritonitis. 

How much did Alfred Worcester 
do to change the accepted practice of 
waiting for an appendiceal abscess to 
form before surgical interference? I 
believe he greatiy influenced physi- 
cians to wake up to the life-saving 
advantages of early operation. The 
reluctance of the medical profession to 
accept a new idea is difficult for us to 
comprehend today, but it has been 
repeatedly demonstrated in the history 
of medicine. 

In the year 1827 Francois Melier 
reported six cases of gangrene of the 
appendix found at autopsy and argued 
for surgical removal of the appendix. 
But his advice was largely ignored due 
to the lack of support from the arro- 
gant Baron Guillaume Dupuytren, the 
leading surgeon of Paris at that time. 
It is a tragedy that the world had to 
wait another 59 years for Reginald Fitz 



to make the same plea. Worcester's 
first appendectomy was done in 
August 1886, several weeks before the 
October appearance of Fitz' s article. 
The forceful and sometimes dra- 
matic way Fitz argued for early surgery 
at meetings of the local medical soci- 
eties and the publication of these con- 
victions in the most respected medical 
journal in his region, the Boston 
Medical and Surgical Journal (which 
became the New England Journal of 
Medicine in 1928), must have per- 
suaded many doctors to operate early 
in such cases, thus saving many lives. 
His vehement insistence on early 
surgery drew considerable criticism 
from many of his fellow practitioners. 
He describes this in a letter to the 
editor published in the New England 
Journal of Medicine on hT^nX 14, 1938: 

"/f was a long time before we Waltham 
men had the support of our professional 
brethren. Instead, we encountered their 
bitter opposition. In various records of 
medical meetings during the next few 
years reports may be found of discussions of 
Waltham, 'j heresy that is, our departure 
from what was then held to be correct pro- 
cedure. At one of the meetings of the 
Suffolk District Medical Society I was 
haTnmered unmercifully. The meeting had 
been called for the discussion of the treat- 
ment of appendicitis. On the blackboard 
were written three questions to which the 
discussion should be confined. 
First: What should be the medical treat- 
ment of appendicitis? 
Second: If surgery is employed, when 
would it supersede medical treatment? 
Third: If surgery is employed, where 
should the incision be made? 

When I was asked to speak I said that 
there is no medical treatment for appen- 
dicitis, that the only proper treatment is 
surgical from the onset of the illness, and 
finally that the incision should be over the 
seat of the trouble. I then exhibited eight 
diseased appendices which we Waltham 
men had removed from our patients. I told 
them that seven of the patients had recov- 
ered and the eighth specimen had been 
taken fi^om a dying man who begged for 



the operation even after I told him there 
was but one chance in a thousand of his 
survival. Then the storm, broke. I was 
asked by an irate surgeon how I dared vio- 
late all surgical principles. I told him that 
it was because I was a coward and did not 
dare not to operate. " 

It is tragic to think about the large 
number of patients who died from 
appendicitis before it became the 
accepted procedure to operate on such 
patients promptly. One might think 
that the several examples of successful 
surgical removal of the diseased 
appendix in 1886, and the publication 
of Fitz's convincing article in October 
of that year would have been sufficient 
to persuade all doctors to recommend 
early surgery for these patients. But 
there was a great deal of inertia and 
reluctance on the part of the conserva- 
tive practitioners. It was outspoken 
men like Alfred Worcester who has- 
tened the day when early surgery was 
the accepted treatment for patients 
with appendicitis. 

I believe that for the people of 

London THE GREAT APPENDECTOMY 
was performed in 1735 by Claudius 
Amyand; for those in the area of 
Fergus, Ontario, it was done in 1883 
by Abraham Groves; for the people of 
Davenport, Iowa, it was William West 
Grant on January 4, 1885. In New 
England, however, it was Alfred 
Worcester who performed THE GREAT 
APPENDECTOMY on August 21, 1886. 

S. Halcuit Moore Jr. ' ^ ^ practiced general 
pediatrics in Dallas until he retired ten 
years ago. Now his days are spent enjoying 
a variety of things, including working out 
at the Baylor Fitness Center, reading bio- 
graphical novels (Irving Stone's are special 
favorites) and occasionally writing a book 
review or other article to pr^esent to his 
discussion club, which meets every month. 



52 



Harvard Medical Alumni Bulletin 









av.. 



:■. »v ■ >" 



'•V. 

'vS./:i;,;,.A-- 



!•'' v..- ' •